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Background <p>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.</p> Methods <p>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).</p> Results <p>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 (<i>p</i> &lt; 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.</p> Conclusions <p>Patients with complex comorbidities, more advanced CKD, and frequent hospitalizations are more likely to be diagnosed with CKD&#xa0;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> Graphical abstract <p></p>

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Differences in chronic kidney disease management based on identification and diagnosis in a population-based observational study

  • 期刊论文

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  • 发表日期：

    2025年9月26日

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  • Michael Olszewski,
  • Karl Bjurström,
  • Markus Lingman,
  • Dan Henrohn,
  • Poyan Shojaiyan,
  • Magnus Garell,
  • Björn Agvall

摘要

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.

Graphical abstract