Differences in chronic kidney disease management based on identification and diagnosis in a population-based observational study
Olszewski, Michael ; Bjurström, Karl ; Lingman, Markus ; Henrohn, Dan ; Shojaiyan, Poyan ; Garell, Magnus and Agvall, Björn LU
(2025)
In Journal of Nephrology
38(9).
p.2809-2820
- Abstract
Background: Chronic kidney disease (CKD) affects 6–10% of adults and often remains undiagnosed until advanced stages, leading to inadequate management. This study compared diagnosed, proxy-diagnosed, and undiagnosed CKD patients regarding prevalence, clinical assessment, nephroprotective treatment, healthcare utilization, and mortality. Methods: This retrospective observational study analyzed Region Halland's healthcare data for adults meeting KDIGO CKD-confirmed criteria for the year 2019. Patients were categorized as diagnosed CKD (ICD-coded), proxy-diagnosed CKD (CKD-related diagnoses), or undiagnosed CKD (meeting CKD criteria without an ICD CKD diagnosis). Results: Of 20,488 CKD patients, 21% had diagnosed CKD, 18% proxy-diagnosed... (More)
Background: Chronic kidney disease (CKD) affects 6–10% of adults and often remains undiagnosed until advanced stages, leading to inadequate management. This study compared diagnosed, proxy-diagnosed, and undiagnosed CKD patients regarding prevalence, clinical assessment, nephroprotective treatment, healthcare utilization, and mortality. Methods: This retrospective observational study analyzed Region Halland's healthcare data for adults meeting KDIGO CKD-confirmed criteria for the year 2019. Patients were categorized as diagnosed CKD (ICD-coded), proxy-diagnosed CKD (CKD-related diagnoses), or undiagnosed CKD (meeting CKD criteria without an ICD CKD diagnosis). Results: Of 20,488 CKD patients, 21% had diagnosed CKD, 18% proxy-diagnosed CKD, and 61% undiagnosed CKD. Mean ages were 76.4, 62.4, and 81.8 years, respectively (p < 0.001). Blood pressure follow-up was carried out in diagnosed CKD (88%) versus 67% and 80% in the proxy-diagnosed and undiagnosed groups. eGFR was tested in 66% overall (73% diagnosed, 53% proxy-diagnosed, 66% undiagnosed), while urine albumin-to-creatinine ratio (UACR) testing was performed in 27% overall (50%, 20%, and 21%, respectively). Renin-angiotensin system inhibitors were prescribed to 45% overall (51%, 28%, and 47%, respectively). The adjusted hospitalization risk was 2.71 (CI: 2.59–2.84) in diagnosed CKD and 1.38 (CI: 1.31–1.46) in proxy-diagnosed CKD. Adjusted all-cause mortality hazard ratios were 2.22 (CI: 1.95–2.52) and 1.31 (CI: 1.08–1.60), respectively. Stratified sensitivity analyses by CKD stage confirmed these associations, though the strength varied. Conclusions: Patients with complex comorbidities, more advanced CKD, and frequent hospitalizations are more likely to be diagnosed with CKD and receive better follow-up care. Proxy-diagnosed CKD was common and associated with suboptimal management. These findings emphasize the need for consistent and accurate CKD identification to improve outcomes and optimize care.
(Less)
- author
- Olszewski, Michael
; Bjurström, Karl
; Lingman, Markus
; Henrohn, Dan
; Shojaiyan, Poyan
; Garell, Magnus
and Agvall, Björn
LU
- organization
- publishing date
- 2025
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Chronic kidney disease, Disease management, Epidemiology, International classification of diseases
- in
- Journal of Nephrology
- volume
- 38
- issue
- 9
- pages
- 2809 - 2820
- publisher
- Springer
- external identifiers
-
- pmid:41006932
- scopus:105017412769
- ISSN
- 1121-8428
- DOI
- 10.1007/s40620-025-02414-2
- language
- English
- LU publication?
- yes
- id
- 1aae2e3a-d46c-4d8d-9299-e720aa704e6e
- date added to LUP
- 2025-12-08 11:12:46
- date last changed
- 2025-12-22 13:37:10
@article{1aae2e3a-d46c-4d8d-9299-e720aa704e6e,
abstract = {{<p>Background: Chronic kidney disease (CKD) affects 6–10% of adults and often remains undiagnosed until advanced stages, leading to inadequate management. This study compared diagnosed, proxy-diagnosed, and undiagnosed CKD patients regarding prevalence, clinical assessment, nephroprotective treatment, healthcare utilization, and mortality. Methods: This retrospective observational study analyzed Region Halland's healthcare data for adults meeting KDIGO CKD-confirmed criteria for the year 2019. Patients were categorized as diagnosed CKD (ICD-coded), proxy-diagnosed CKD (CKD-related diagnoses), or undiagnosed CKD (meeting CKD criteria without an ICD CKD diagnosis). Results: Of 20,488 CKD patients, 21% had diagnosed CKD, 18% proxy-diagnosed CKD, and 61% undiagnosed CKD. Mean ages were 76.4, 62.4, and 81.8 years, respectively (p < 0.001). Blood pressure follow-up was carried out in diagnosed CKD (88%) versus 67% and 80% in the proxy-diagnosed and undiagnosed groups. eGFR was tested in 66% overall (73% diagnosed, 53% proxy-diagnosed, 66% undiagnosed), while urine albumin-to-creatinine ratio (UACR) testing was performed in 27% overall (50%, 20%, and 21%, respectively). Renin-angiotensin system inhibitors were prescribed to 45% overall (51%, 28%, and 47%, respectively). The adjusted hospitalization risk was 2.71 (CI: 2.59–2.84) in diagnosed CKD and 1.38 (CI: 1.31–1.46) in proxy-diagnosed CKD. Adjusted all-cause mortality hazard ratios were 2.22 (CI: 1.95–2.52) and 1.31 (CI: 1.08–1.60), respectively. Stratified sensitivity analyses by CKD stage confirmed these associations, though the strength varied. Conclusions: Patients with complex comorbidities, more advanced CKD, and frequent hospitalizations are more likely to be diagnosed with CKD and receive better follow-up care. Proxy-diagnosed CKD was common and associated with suboptimal management. These findings emphasize the need for consistent and accurate CKD identification to improve outcomes and optimize care.</p>}},
author = {{Olszewski, Michael and Bjurström, Karl and Lingman, Markus and Henrohn, Dan and Shojaiyan, Poyan and Garell, Magnus and Agvall, Björn}},
issn = {{1121-8428}},
keywords = {{Chronic kidney disease; Disease management; Epidemiology; International classification of diseases}},
language = {{eng}},
number = {{9}},
pages = {{2809--2820}},
publisher = {{Springer}},
series = {{Journal of Nephrology}},
title = {{Differences in chronic kidney disease management based on identification and diagnosis in a population-based observational study}},
url = {{http://dx.doi.org/10.1007/s40620-025-02414-2}},
doi = {{10.1007/s40620-025-02414-2}},
volume = {{38}},
year = {{2025}},
}