Prevalence and recognition of chronic kidney disease in Stockholm healthcare

Gasparini, Alessandro; Evans, Marie; Coresh, Josef; Grams, Morgan E.; Norin, Olof; Qureshi, Abdul Rashid; Runesson, Björn; Bárány, Peter; Ärnlöv, Johan; Jernberg, Tomas; Wettermark, Björn; Elinder, Carl Gustaf; Carrero, Juan Jesús

doi:10.1093/ndt/gfw354

Cited by 105 publications

(107 citation statements)

References 46 publications

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“…It is therefore uncertain if the true prevalence of RIMs in all older people in Stockholm County is lower or higher than reported. In a similar Swedish primary care population, 95% of patients had their creatinine value checked as well as >75% in SCREAM, speaking in favour of an accurate estimation in our study.…”

Section: Discussionmentioning

confidence: 51%

Prevalence of renally inappropriate medicines in older people with renal impairment — A cross‐sectional register‐based study in a large primary care population

Schmidt‐Mende

Wettermark

Andersen

et al. 2018

Basic Clin Pharma Tox

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The aim of this population‐based, cross‐sectional study was to analyse the prevalence of renally inappropriate medicines (RIMs) in older people with renal impairment. We included 30 372 people aged ≥65 years with chronic kidney disease (CKD) stage 3, and 2161 with stage 4 attending primary care in Stockholm, Sweden. We used data derived from SCREAM, a database linking patient‐specific data on demography, morbidity, healthcare consumption and dispensed drugs to creatinine measurements. Estimated glomerular filtration rate was calculated with CKD‐EPI based on the first non‐hospital serum creatinine in 2010. RIMs were defined as medicines needing dose adjustment or being contra‐indicated in CKD stage 3 or 4 with reference to Swedish “Janusmed Drugs and Renal function.” Dispensed prescription drugs were analysed during 1 year after creatinine assessment. Drug doses were considered as excessive if their mean volume dispensed per day exceeded the recommended dose. Contra‐indicated medicines were regarded as inappropriate if dispensed at least once during 1 year. Excessive dosing was present in 42.5% of older people with CKD stage 3 and in 58.1% with stage 4. The prevalence of contra‐indicated medicines was 9.4% and 38.0%, respectively. A limited number of RIMs accounted for the majority of excessive dosing, such as drugs acting on the renin‐angiotensin‐aldosterone system, betablockers and opioids. Commonly dispensed contra‐indicated substances were NSAIDs and antidiabetics. We conclude that the prevalence of RIMs in older people with renal impairment is considerably high. Still, RIM use may be manageable as only a limited number of RIMs are frequently used.

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Section: Discussionmentioning

confidence: 51%

Prevalence of renally inappropriate medicines in older people with renal impairment — A cross‐sectional register‐based study in a large primary care population

Schmidt‐Mende

Wettermark

Andersen

et al. 2018

Basic Clin Pharma Tox

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“…However, this result should be interpreted with caution as data on renal function results were sparse (unregistered data for renal failure up to 77.9%). In fact, a study aiming to report CKD prevalence and recognition in a Swedish healthcare cohort showed that registration of CKD diagnosis was suboptimal, with only 12% of affected patients having an ICD‐10 related diagnostic code . However, we suspect these unregistered values are more likely to reflect less severe impairment.…”

Section: Discussionmentioning

confidence: 90%

Incidence of direct oral anticoagulant use in patients with nonvalvular atrial fibrillation and characteristics of users in 6 European countries (2008–2015): A cross‐national drug utilization study

Ibáñez

Sabaté

Vidal

et al. 2019

Brit J Clinical Pharma

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AimsTo estimate the incidence of direct oral anticoagulant drug (DOAC) use in patients with nonvalvular atrial fibrillation and to describe user and treatment characteristics in 8 European healthcare databases representing 6 European countries.MethodsLongitudinal drug utilization study from January 2008 to December 2015. A common protocol approach was applied. Annual period incidences and direct standardisation by age and sex were performed. Dose adjustment related to change in age and by renal function as well as concomitant use of potentially interacting drugs were assessed.ResultsA total of 186 405 new DOAC users (age ≥18 years) were identified. Standardized incidences varied from 1.93–2.60 and 0.11–8.71 users/10 000 (2011–2015) for dabigatran and rivaroxaban, respectively, and from 0.01–8.12 users/10 000 (2012–2015) for apixaban. In 2015, the DOAC incidence ranged from 9 to 28/10 000 inhabitants in SIDIAP (Spain) and DNR (Denmark) respectively. There were differences in population coverage among the databases. Only 1 database includes the total reference population (DNR) while others are considered a population representative sample (CPRD, BIFAP, SIDIAP, EGB, Mondriaan). They also varied in the type of drug data source (administrative, clinical). Dose adjustment ranged from 4.6% in BIFAP (Spain) to 15.6% in EGB (France). Concomitant use of interacting drugs varied between 16.4% (SIDIAP) and 70.5% (EGB). Cardiovascular comorbidities ranged from 25.4% in Mondriaan (The Netherlands) to 82.9% in AOK Nordwest (Germany).ConclusionOverall, apixaban and rivaroxaban increased its use during the study period while dabigatran decreased. There was variability in patient characteristics such as comorbidities, potentially interacting drugs and dose adjustment. (EMA/2015/27/PH).

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“…As a consequence, the treatment rate among women is lower compared to men, even in subjects with known CKD (39.6% in women versus 45.5% in men), as was shown in a cross-sectional study performed in 12 low- and middle-income countries [18]. The data regarding the CKD treatment rate in the general population of high-income countries is not available, but awareness of CKD [19] and a formal diagnosis with referrals to a nephrologist [20] was lower in women, a finding that could indicate similar general social mechanisms to the approach to gender roles across low-, middle-, and high-income countries. A constellation of extremely challenging economic conditions, as well as women’s social roles as non-wage earners in some patriarchal societies may be what leads to the extremely high male:female ratio observed in our analysis in the context of dialysis and kidney transplant prevalence rates.…”

Section: Discussionmentioning

confidence: 99%

Disparities in Chronic Kidney Disease Prevalence among Males and Females in 195 Countries: Analysis of the Global Burden of Disease 2016 Study

Bikbov

Perico

Remuzzi³

2018

Nephron

183

117

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Background: Chronic kidney disease (CKD) imposes a substantial burden on health care systems. There are some especially vulnerable groups with a high CKD burden, one of which is women. We performed an analysis of gender disparities in the prevalence of all CKD stages and renal replacement therapy (defined as impaired kidney function [IKF]) in 195 countries. Methods: We used estimates produced by the Global Burden of Disease (GBD) Study 2016 revision using a Bayesian-regression analytic tool, DisMoD-MR 2.1. Data on gross domestic product based on purchasing power parity per capita (GDP PPP) was obtained via the World Bank International Comparison Program database. To estimate gender disparities, we calculated the male:female all-age prevalence rate ratio for each IKF condition. Results: In 2016, the global number of individuals with IKF reached 752.7 million, including 417.0 million females and 335.7 million males. The most prevalent form of IKF in both groups was albuminuria with preserved glomerular filtration rate. Geospatial analysis shows a very heterogeneous distribution of the male:female ratio for all IKF conditions, with the most prominent contrast found in kidney transplant patients. The median male:female ratio varies substantially according to GDP PPP quintiles; however, countries with different economic states could have similar male:female ratios. A strong correlation of GDP PPP with dialysis-to-transplant ratio was found. Conclusions: The GBD study highlights the prominent gender disparities in CKD prevalence among 195 countries. The nature of these disparities, however, is complex and must be interpreted cautiously taking into account all possible circumstances.

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Prevalence and recognition of chronic kidney disease in Stockholm healthcare

Cited by 105 publications

References 46 publications

Prevalence of renally inappropriate medicines in older people with renal impairment — A cross‐sectional register‐based study in a large primary care population

Prevalence of renally inappropriate medicines in older people with renal impairment — A cross‐sectional register‐based study in a large primary care population

Incidence of direct oral anticoagulant use in patients with nonvalvular atrial fibrillation and characteristics of users in 6 European countries (2008–2015): A cross‐national drug utilization study

Disparities in Chronic Kidney Disease Prevalence among Males and Females in 195 Countries: Analysis of the Global Burden of Disease 2016 Study

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