Chronic kidney disease in Romania: national adjusted prevalence, risk factors, and temporal trends in high-risk groups.

BACKGROUND: Chronic kidney disease (CKD) is a growing global health concern, associated with substantial morbidity and mortality. In Romania, national-level data on CKD prevalence remain limited. This study aimed to estimate the prevalence and risk factors of CKD in Romania using two independent cohorts: a general population cohort (2007–2008) and a targeted high-risk cohort (2023) consisting of individuals with hypertension, diabetes, or cardiovascular disease. METHODS: The general population cohort (N = 26,831) was derived from a national health survey in Iassy. The 2023 targeted cohort (N = 2,247) was screened using a structured, software-assisted protocol by general practitioners in Bucharest. CKD was defined as eGFR < 60 mL/min/1.73 m² and/or albuminuria ≥ 30 mg/g; the 3-month chronicity criterion was applied only in the 2023 cohort. Risk categories for CKD progression (moderate, high, very high) were assigned according to KDIGO definitions. RESULTS: The standardized national prevalence of CKD was 8.97%. CKD prevalence in the high-risk 2023 cohort was 27%, compared to 18% in a matched at-risk group from the 2007–2008 cohort. Most CKD cases were at moderate risk, though the proportion of very high-risk individuals increased over time (7.6% to 10.5%). Targeted screening doubled detection efficiency (number needed to screen = 4 vs. 7). CONCLUSION: CKD is a public health issue in Romania, particularly among individuals with cardiometabolic comorbidities. Targeted screening improves detection efficiency and may serve as a cost-effective strategy to reduce disease burden.