在现实环境中,对未记录的慢性肾病 3 期患者的监测和管理不够理想:来自 REVEAL-CKD 的启示。

IF 4.4 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Navdeep Tangri, Christian S. Alvarez, Matthew Arnold, Salvatore Barone, Ana Cebrián, Hungta Chen, Luca De Nicola, Krister Järbrink, Naresh Kanumilli, Kean-Seng Lim, Toshiki Moriyama, Roberto Pecoits Filho, Maria Cristina Ribeiro de Castro, Rafael Santamaria, Markus P. Schneider, Jean Blaise Virgitti, Pamela Kushner
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引用次数: 0

摘要

背景:慢性肾脏病(CKD)患者临床实践指南建议定期监测和管理肾功能及CKD风险因素。目的:评估无诊断代码记录的 CKD 3 期患者在现实世界中实施指南指导的监测和管理方法的情况:REVEAL-CKD(NCT04847531)是一项针对 3 期 CKD 患者的跨国观察性研究。符合条件的患者需连续进行≥2次估算肾小球滤过率(eGFR)测量,测量结果显示其为3期CKD,测量时间间隔大于90天且小于730天,在进行第二次eGFR测量之前的任何时间以及测量之后的6个月内没有与CKD相对应的国际疾病分类9/10诊断代码。对护理质量的关键指标进行了测试评估:该研究包括来自 9 个国家的 435,971 名患者。在所有国家中,尿白蛋白-肌酐比值和白蛋白尿检测的普及率都很低。血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂和他汀类药物的处方变化很大,钠-葡萄糖共转运体-2 抑制剂的处方仍然低于 21%。20.2%-89.9%的患者有血压测量记录:总体而言,有证据显示为 CKD 3 期的大部分患者没有接受建议的、指南指导的监测和管理。各国护理标准的差异表明,有明显的机会改善对这些患者的监测和管理,从而很可能改善长期预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Suboptimal monitoring and management in patients with unrecorded stage 3 chronic kidney disease in real-world settings: Insights from REVEAL-CKD

Suboptimal monitoring and management in patients with unrecorded stage 3 chronic kidney disease in real-world settings: Insights from REVEAL-CKD

Background

Clinical practice guidelines for patients with chronic kidney disease (CKD) recommend regular monitoring and management of kidney function and CKD risk factors. However, the majority of patients with stage 3 CKD lack a diagnosis code, and data on the implementation of these recommendations in the real world are limited.

Aim

To assess the implementation of guideline-directed monitoring and management practices in the real world in patients with stage 3 CKD without a recorded diagnosis code.

Methods

REVEAL-CKD (NCT04847531) is a multinational, observational study of patients with stage 3 CKD. Eligible patients had ≥2 consecutive estimated glomerular filtration rate (eGFR) measurements indicative of stage 3 CKD recorded >90 and ≤730 days apart, lacked an International Classification of Diseases 9/10 diagnosis code corresponding to CKD any time before and up to 6 months after the second eGFR measurement. Testing of key measures of care quality were assessed.

Results

The study included 435,971 patients from 9 countries. In all countries, the prevalence of urinary albumin–creatinine ratio and albuminuria testing was low. Angiotensin-converting enzyme inhibitor, angiotensin receptor blocker and statin prescriptions were highly variable, and sodium–glucose cotransporter-2 inhibitor prescriptions remained below 21%. Blood pressure measurements were recorded in 20.2%–89.9% of patients.

Conclusions

Overall, a large proportion of patients with evidence of stage 3 CKD did not receive recommended, guideline-directed monitoring and management. The variability in standard of care among countries demonstrates a clear opportunity to improve monitoring and management of these patients, most likely improving long-term outcomes.

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来源期刊
CiteScore
9.50
自引率
3.60%
发文量
192
审稿时长
1 months
期刊介绍: EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.
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