Skip to main content
SpringerLink
Log in

Awareness of chronic kidney disease in Austria: a frequently under-recognized clinical picture

Krankheitsbewusstsein der chronischen Niereninsuffizienz in Österreich – ein häufig unerkanntes Krankheitsbild

  • original article
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Summary

Background

The prevalence of chronic kidney disease (CKD) is rising at an alarming rate, thus presenting a substantial burden for the patient as an individual and—because of the enormous treatment costs—for society as a whole. Early diagnosis and therapy could slow disease progression and reduce the prevalence of cost-intensive end stage renal disease. The aim of this study was to determine the accuracy of diagnosis of CKD in acute patients presenting at an internal ward.

Methods

Routine laboratory parameters of kidney function of 238 inpatients were retrospectively evaluated to determine the prevalence of CKD, defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. Those results were compared with the actual documentation of the ICD-10 diagnosis CKD in the discharge reports of the respective patients.

Results

Of 238 patients, 228 patients were included in the analysis. The overall median (range) eGFR was 60.7 (10.4–171.9) mL/min/1.73 m2, with no gender-specific difference. Of patients, 49.6 % (n = 113) were retrospectively diagnosed with CKD stage 3 or higher. However, the review of the discharge reports found correct diagnosis of CKD in only 38.1 % (n = 43) of these patients.

Conclusions

The present analysis shows that CKD remains frequently unrecognized, even in a hospital setting. This could have dramatic implications on the care, treatment and prevention of CKD and associated complications.

Zusammenfassung

Hintergrund

Die chronische Niereninsuffizienz ist eine Erkrankung mit stetig zunehmender Prävalenz. Neben erhöhter Morbidität und Mortalität ist die Belastung für das Gesundheitsbudget durch die chronische Niereninsuffizienz enorm. Die frühzeitige Diagnose und Therapie kann das kostenintensive Endstadium der Krankheit verhindern bzw. zeitlich verzögern. In der aktuellen Studie wurde untersucht, zu welchem Prozentsatz eine vorhandene chronische Niereninsuffizienz bei stationären Patienten korrekt erkannt wurde.

Methodik

In einer retrospektiven Analyse wurden die Daten von 238 allgemein internistischen Akutpatienten an der Universitätsklinik für Innere Medizin Graz evaluiert und die Prävalenz der chronischen Niereninsuffizienz, definiert als geschätzte glomeruläre Filtrationsrate < 60 mL/min/1,73 m2, bestimmt. Diese Daten wurden in Hinblick auf Erfassung der Erkrankung im Entlassungsarztbrief verglichen.

Ergebnisse

Von 238 Patienten wurden 228 analysiert. Die mediane (Bereich) geschätzte glomeruläre Filtrationsrate betrug 60,7 (10,4–171,9) mL/min/1,73 m2, wobei keine geschlechtsspezifischen Unterschiede gefunden wurden. Eine chronische Niereninsuffizienz im Stadium 3 oder höher wurde bei 49,6 % der Patienten (n = 113) nachgewiesen. Die Erhebung der Diagnosen in den Entlassungsarztbriefen ergab, dass die Erkrankung bei lediglich 38,1 % der betroffenen Patienten in der ICD-10 Codierung als Solche erfasst wurde.

Schlussfolgerungen

Diese Analyse zeigt eine deutliche „Unterdiagnose“ der chronischen Niereninsuffizienz, sogar in einem stationären allgemein internistischen Setting. Das könnte dramatische Folgen für die Behandlung und Prävention der chronischen Niereninsuffizienz und ihrer assoziierten Komplikationen haben.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Levey AS, Atkins R, Coresh J, et al. Chronic kidney disease as a global public health problem: approaches and initiatives—a position statement from kidney disease improving global outcomes. Kidney Int. 2007;72(3):247–59.

    Article  PubMed  CAS  Google Scholar 

  2. White SL, Polkinghorne KR, Atkins RC, et al. Comparison of the prevalence and mortality risk of CKD in Australia using the CKD Epidemiology Collaboration (CKD-EPI) and modification of diet in renal disease (MDRD) Study GFR estimating equations: the AusDiab (Australian diabetes, obesity and lifestyle) Study. Am J Kidney Dis. 2010;55(4):660–70.

    Article  PubMed  Google Scholar 

  3. Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298(17):2038–47.

    Article  PubMed  CAS  Google Scholar 

  4. OʼHare AM, Kaufman JS, Covinsky KE, et al. Current guidelines for using angiotensin-converting enzyme inhibitors and angiotensin II-receptor antagonists in chronic kidney disease: is the evidence base relevant to older adults? Ann Internal Med. 2009;150(10):717–24.

    Article  Google Scholar 

  5. Weiner DE, Tighiouart H, Stark PC, et al. Kidney disease as a risk factor for recurrent cardiovascular disease and mortality. Am J Kidney Dis. 2004;44(2):198–206.

    Article  PubMed  Google Scholar 

  6. Keith DS, Nichols GA, Gullion CM, et al. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Internal Med. 2004;164(6):659–63.

    Article  Google Scholar 

  7. Tonelli M, Wiebe N, Culleton B, et al. Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol. 2006;17(7):2034–47.

    Article  PubMed  Google Scholar 

  8. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296–305.

    Article  PubMed  CAS  Google Scholar 

  9. Anandarajah S, Tai T, de Lusignan S, et al. The validity of searching routinely collected general practice computer data to identify patients with chronic kidney disease (CKD): a manual review of 500 medical records. Nephrol Dial Transplant. 2005;20(10):2089–96.

    Article  PubMed  Google Scholar 

  10. Middleton RJ, Foley RN, Hegarty J, et al. The unrecognized prevalence of chronic kidney disease in diabetes. Nephrol Dial Transplant. 2006;21(1):88–92.

    Article  PubMed  Google Scholar 

  11. Gilbertson DT, Liu J, Xue JL, et al. Projecting the number of patients with end-stage renal disease in the United States to the year 2015. J Am Soc Nephrol. 2005;16(12):3736–41.

    Article  PubMed  Google Scholar 

  12. Foley RN, Murray AM, Li S, et al. Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998–1999. J Am Soc Nephrol. 2005;16(2):489–95.

    Article  PubMed  Google Scholar 

  13. Kerr M, Bray B, Medcalf J, et al. Estimating the financial cost of chronic kidney disease to the NHS in England. Nephrol Dial Transplant. 2012;27(Suppl 3):iii73–iii80.

    Article  PubMed  Google Scholar 

  14. Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. modification of diet in renal disease study group. Ann Internal Med. 1999;130(6):461–70.

    Article  CAS  Google Scholar 

  15. Ferris M, Shoham DA, Pierre-Louis M, et al. High prevalence of unlabeled chronic kidney disease among inpatients at a tertiary-care hospital. Am J Med Sci. 2009;337(2):93–7.

    Article  PubMed  Google Scholar 

  16. Gentile G, Postorino M, Mooring RD, et al. Estimated GFR reporting is not sufficient to allow detection of chronic kidney disease in an Italian regional hospital. BMC Nephrol. 2009;10:24.

    Article  PubMed  Google Scholar 

  17. Minutolo R, De Nicola L, Mazzaglia G, et al. Detection and awareness of moderate to advanced CKD by primary care practitioners: a cross-sectional study from Italy. Am J Kidney Dis. 2008;52(3):444–53.

    Article  PubMed  Google Scholar 

  18. Zhou XJ, Rakheja D, Yu X, et al. The aging kidney. Kidney Int. 2008;74(6):710–20.

    Article  PubMed  CAS  Google Scholar 

  19. Black C, Sharma P, Scotland G, et al. Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis. Health Technol Assess. 2010;14(21):1–184.

    PubMed  CAS  Google Scholar 

  20. Levin A, Bakris GL, Molitch M, et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int. 2007;71(1):31–8.

    Article  PubMed  CAS  Google Scholar 

  21. KDIGO Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2012;3(Suppl 1):1–150.

    Google Scholar 

  22. Kramar R, Oberbauer R. Austrian Dialysis and Transplantation Registry (OEDTR), Annual Report 2011. Austrian Society of Nephrology; 2011.

  23. Grassmann A, Gioberge S, Moeller S, et al. ESRD patients in 2004: global overview of patient numbers, treatment modalities and associated trends. Nephrol Dial Transplant. 2005;20(12):2587–93.

    Article  PubMed  Google Scholar 

  24. Lysaght MJ. Maintenance dialysis population dynamics: current trends and long-term implications. J Am Soc Nephrol. 2002;13(Suppl 1):S37–40.

    PubMed  Google Scholar 

  25. Matzke GR, Aronoff GR, Atkinson AJ Jr., et al. Drug dosing consideration in patients with acute and chronic kidney disease—a clinical update from kidney disease: improving global outcomes (KDIGO). Kidney Int. 2011;80(11):1122–37.

    Article  PubMed  CAS  Google Scholar 

  26. Hug BL, Witkowski DJ, Sox CM, et al. Occurrence of adverse, often preventable, events in community hospitals involving nephrotoxic drugs or those excreted by the kidney. Kidney Int. 2009;76(11):1192–8.

    Article  PubMed  Google Scholar 

  27. Akbari A, Grimshaw J, Stacey D, et al. Change in appropriate referrals to nephrologists after the introduction of automatic reporting of the estimated glomerular filtration rate. CMAJ. 2012;184(5):E269–E76.

    PubMed  Google Scholar 

  28. Hobbs H, Stevens P, Klebe B, et al. Referral patterns to renal services: what has changed in the past 4 years? Nephrol Dial Transplant. 2009;24(11):3411–9.

    Article  PubMed  Google Scholar 

  29. National Kidney F. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1–266.

    Article  Google Scholar 

  30. Poggio ED, Nef PC, Wang X, et al. Performance of the Cockcroft—Gault and modification of diet in renal disease equations in estimating GFR in ill hospitalized patients. Am J Kidney Dis. 2005;46(2):242–52.

    Article  PubMed  Google Scholar 

  31. Newhouse JH, Kho D, Rao QA, et al. Frequency of serum creatinine changes in the absence of iodinated contrast material: implications for studies of contrast nephrotoxicity. AJR. 2008;191(2):376–82.

    Article  PubMed  Google Scholar 

  32. Kurtal H, Schwenger V, Azzaro M, et al. Clinical value of automatic reporting of estimated glomerular filtration rate in geriatrics. Gerontology. 2009;55(3):288–95.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

All authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 27, 8036, Graz, Austria

    Claudia Friedl & Alexander R. Rosenkranz

  2. Hemetsberger Medical Services, Vienna, Austria

    Margit Hemetsberger

  3. Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria

    Julia Mader, Astrid Fahrleitner-Pammer & Thomas R. Pieber

Authors
  1. Claudia Friedl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Margit Hemetsberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julia Mader
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Astrid Fahrleitner-Pammer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas R. Pieber
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alexander R. Rosenkranz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander R. Rosenkranz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Friedl, C., Hemetsberger, M., Mader, J. et al. Awareness of chronic kidney disease in Austria: a frequently under-recognized clinical picture. Wien Klin Wochenschr 125, 362–367 (2013). https://doi.org/10.1007/s00508-013-0374-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-013-0374-7

Keywords

Schlüsselwörter

Search

Navigation