Screening for chronic kidney disease in Belgrade primary health care centers

Abstract

Introduction. Academy of Medical Science of Serbian Medical Societyintroduced collaboration between Belgrade nephrologistsand general practitioners with the aim of examining the prevalenceof chronic kidney disease (CKD) in populations at risk as well as ofchecking whether collaboration with general practitioners contributedto implementation of regular CKD screening.Methods. The research encompassed two studies carried out infour Belgrade Primary Health Care Centers. The screening study involved619 patients at risk for CKD (348 with hypertension, 206 withdiabetes, 65 persons aged > 60 years without hypertension/diabetes)in whom glomerular filtration rate (eGFR) was estimated byMDRD formula, while urine dipstick test was used for detection ofproteinuria and albuminuria (Micral-test® strips).The second studywas retrospective analysis of medical records of 450 patients whowere examined in the screening study and whose blood pressureand eGFR recording were analyzed during three-year period.Results. In screening study, eGFR below 60 ml/min/1.73m2 wasdetected in 121 (19.55%) and albuminuria in 242 (39.10%) patients.During three-year retrospective study, percentage of patientswhose blood pressure and eGFR were recorded decreasedfrom 42% to 22% and from 42% to 18%, respectively. Multivariateregression analysis selected health center, systolic blood pressureand hypertension as the variables significantly associated with thenumber of years in which blood pressure was recorded, while malegender, health center, hypertension and basal eGFR as variablesassociated with the number of years in which eGFR was recorded.Conclusion. Despite collaboration between nephrologists andgeneral practitioners in screening study, the retrospective threeyearstudy revealed insufficient recording of blood pressure andeGFR in patients’ medical records.

Screening for chronic kidney disease

“…The studies such as Ležaić et al [6] and Djukanović et al [7] detected eGFR less than 60 ml/min/1.73m 2 in 19.5% and elevated albuminuria in 39.1% of population at high risk. Nowadays, the same authors present follow-up data with the aim of demonstrating consistency in screening and monitoring of CKD patients after detailed initial education [8]. Unfortunately, awareness of primary care physicians has declined, thus indicating that individual screening programs are rarely maintained without the wide support of responsible institutions.…”

“…While these strategies are not available, screening of population at high risk by using eGFR and the level of albuminuria, presented in paper by Krsmanović [5], is the best way for early diagnosis and preventive strategy in elderly, diabetic and hypertensive patients. Paper by Djukanović and Ležaić [8] teaches us that awareness of continuous screening is not easy to build. It demands considerable amount of continuous work from the side of a nephrologist to achieve successful cooperation with primary care physicians.…”