Chronic kidney disease in patients with diabetes mellitus type 2 or hypertension in general practice

Abstract

The prevalence and severity of chronic kidney disease (CKD) in primary care patients with diabetes or hypertension is unknown. AimTo assess the prevalence and severity of CKD in patients with diabetes and hypertension; and identify whether age, sex, diabetes, and hypertension are associated with CKD. Design of studyCross-sectional survey. SettingTwo Dutch primary health care centres (15 954 enlisted patients). MethodPatients, aged ≥25 years, with known diabetes type 2 (n = 471) or hypertension (n = 960), were selected on 1 October 2006. Initial screening uptake rates were assessed from the electronic patient records, and patients were invited when blood or urine measurements were missing. The presence of albuminuria was determined, glomerular filtration rate estimated, and clinical characteristics extracted. ResultsInitial screening uptake rates were 93% and 69% for diabetes and hypertension, respectively, and increased to 97% (n = 455) and 87% (n = 836) after active invitation. The prevalence of CKD was 28% in diabetes and 21% in hypertension only. The presence of diabetes was independently associated with albuminuria (odds ratio [OR] 4.23; 95% confidence interval [CI] = 2.67 to 6.71), but not with decreased estimated GFR (eGFR) (OR 0.75; 95% CI = 0.54 to 1.04). Age showed the strongest association with decreased eGFR (OR 2.73; 95% CI = 2.02 to 3.70). ConclusionIn primary care, more than one-quarter of patients with diabetes and about one-fifth of patients with hypertension have CKD. The high prevalence justifies longitudinal follow-up in order to evaluate whether intensified cardiovascular risk management is beneficial in this primary care population.

Evaluating Kidney Function in Elderly Population: A Cross-Sectional Study in Primary Health Care

“…Ageing was found significantly associated with CKD, being in line with previous findings [1,16] Since mild and moderate kidney disease is poorly described from serum creatinine alone, clinical laboratories could routinely estimate GFR and report the value when serum creatinine is measured. Such an initiative could significantly help health care providers to early detect CKD among patients with risk factors, but also monitor patients already diagnosed with CKD.…”

“…There are a few published studies in primary care settings reporting on the identification of chronic kidney disease [1,[13][14][15][16][17][18], while no study has been previously published on the prevalence of CKD in Greek primary care patients. The aim of this study was to identify the prevalence of CKD among the elderly population in primary care settings and the extent to which serum creatinine reflects kidney function.…”

“…Ageing and a number of common chronic diseases like hypertension, diabetes mellitus, cardiovascular disease and their treatments are associated with significant modifications of kidney function [1][2][3]. Especially, ageing is frequently associated with loss of muscle mass, but also determines changes in kidney structure, since it is associated with a loss of renal mass by about one fourth from 30 to 80 years of age [4], and a decrease in kidneys' length by 15% from 17 to 85 years of age [5].…”

Hypertension and the development of New onset chronic kidney disease over a 10 year period: a retrospective cohort study in a primary care setting in Malaysia

“…Our study has also shown that one of the factors associated with the development of new onset CKD is the presence of diabetes in hypertension. Many studies have reported similar findings [13,27]. One of the reasons for an increased deterioration in glomerular filtration is that diabetes itself causes renal damage, and the added presence of hypertension amplifies the vascular damage leading to further renal insufficiency [28-30].…”

Prevalence of chronic kidney disease in patients with type 2 diabetes in Spain: PERCEDIME2 study

“…In another study in Spain [8] the prevalence off different types of renal disease in DM2 was: 34,1% for any type of CKD, 22,9% RI and 19,5% for albuminuria. In a study performed in primary care centres in the Netherlands, van der Meer et al [18] observed that 27.6% of DM2 patients had CKD and that 13.6% of these DM2 patients had albuminuria. Another study in the United Kingdom [19] showed that 31% of diabetic patients had a GFR < 60 ml/min/1.73 m 2 and 37% of these patients had albuminuria.…”