High Prevalence of Unrecorded Stage 3 Chronic Kidney Disease in Australia, Brazil, Canada, England, and Spain: The Multinational, Observational REVEAL-CKD Study
Roberto Pecoits-Filho, Kean-Seng Lim, Maria Cristina Ribeiro de Castro, Ana Cebrian, Rafael Santamaria, Naresh Kanumilli, Christian S. Alvarez, Matthew Arnold, Salvatore Barone, Hungta Chen, Krister Järbrink, Navdeep Tangri
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Abstract
Background: Chronic kidney disease (CKD) is a global public health concern, affecting approximately 850 million people worldwide. Guidelines recommend early identification and management of CKD to mitigate disease progression and delay the onset of complications. Recording a CKD diagnosis in medical records is associated with improved kidney function and blood pressure monitoring, better use of disease-modifying therapy, and reduced risk of CKD progression. REVEAL-CKD is a multinational, observational study that aims to estimate the prevalence of stage 3 CKD which is unrecorded in administrative databases.
Methods: Data were extracted from country-specific databases of patient medical records in Australia, Brazil, Canada, England, and Spain. Included patients (aged ≥ 18 years) had two consecutive estimated glomerular filtration rate (eGFR) measurements between 30 and < 60 mL/min/1.73 m2 taken 91–730 days apart. Patients were considered to have unrecorded CKD if they had no CKD diagnosis code (any stage) at any time before and up to 6 months after study index (date of second qualifying eGFR).
Results: Across countries, median age was 72–78 years, median eGFR was 46.5–53.5 mL/min/1.73 m2, and availability of urinary albumin—creatinine ratio testing ranged from 4.9% (Brazil) to 53.5% (Canada). The prevalence of unrecorded stage 3 CKD was 90.0% (1002/1113 patients) in Australia, 97.0% (10,925/11,262) in Brazil, 92.0% (42,226/45,914) in Canada, 56.9% (84,237/148,153 in England, and 84.8% (27,035/31,866) in Spain.
Conclusions: More than half of the patients with laboratory evidence of stage 3 CKD lacked a CKD diagnosis code in all countries examined. Substantial intercountry variations in rates of CKD recording and testing were observed. International sharing of best practice guidance, systematic changes to improve data quality, and increased awareness of the importance of timely coding among healthcare professionals will help to improve accurate recording of stage 3 CKD.
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