Missed Opportunities in the Diagnosis and Management of Stage 3 Chronic Kidney Disease in General Practice: Insights From the Italian THIN Database
Author(s)
Pietro Ferrara, PhD, MD1, Davide Rozza, PhD1, Ippazio Cosimo Antonazzo, PhD1, Manuel Zamparini, MSc1, Lorenzo Losa, MD1, Elena Zanzottera Ferrari, MSc2, Pasquale Palladino, MSc2, Lorenzo G Mantovani, DSc1, Giampiero Mazzaglia, MD PhD1, Carla Fornari, PhD3.
1Center for Public Health Research (CESP), University of Milan-Bicocca, Monza, Italy, 2Cegedim Health Data, Milan, Italy, 3Research Center on Public Health, University of Milan-Bicocca, Monza, Italy.
1Center for Public Health Research (CESP), University of Milan-Bicocca, Monza, Italy, 2Cegedim Health Data, Milan, Italy, 3Research Center on Public Health, University of Milan-Bicocca, Monza, Italy.
OBJECTIVES: Chronic kidney disease (CKD) represents a major public health challenge and is often underdiagnosed. This study analysed case-finding practices and clinical management of stage 3 CKD (CKD-3) in general practice (GP) settings.
METHODS: A national cohort study was conducted using the Italian THIN® database to identify kidney disease-naïve individuals with an estimated glomerular filtration rate (eGFR) indicative of CKD-3 (30-59 mL/min/1.73 m²). Rates of repeat serum creatinine testing after ≥90 days, nephrology referrals, and diagnosis confirmation were assessed. Poisson regression models estimated factors associated with each outcome.
RESULTS: Among 347,548 eligible individuals, 18,002 had an eGFR indicative of CKD-3; only 8.3% were concurrently tested for urinary albumin-to-creatinine ratio, with 479 showing values ≥30 mg/g. In this subgroup, 67.6% received a second creatinine test and 12.9% were referred to a nephrologist. In the overall population, older patients (prevalence ratio [PR] 1.24; 95% CI: 1.08-1.41), males (PR 1.05; 1.03-1.08), individuals with hypertension (PR 1.05; 1.01-1.09), cardiovascular diseases (PR 1.07; 1.04-1.11), or HbA1c >6.5% (PR 1.09; 1.04-1.13) were more likely to undergo repeat creatinine testing. Referral to nephrology care was less likely with increasing age but more common among males (PR 1.76; 1.60-1.94), individuals with hypertension (PR 1.25; 1.07-1.47), diabetes (PR 1.53; 1.35-1.72), elevated albuminuria (PR 1.42; 1.12-1.81), high uric acid levels (PR 1.53; 1.28-1.82), NSAID use (PR 1.13; 1.01-1.26), or diuretic use (PR 1.45; 1.31-1.61). Diagnosis confirmation was more likely in the presence of cardiovascular disease (PR 1.13; 1.04-1.23), HbA1c >6.5% (PR 1.19; 1.07-1.32), and diuretic use (PR 1.34; 1.24-1.44).
CONCLUSIONS: The study highlights significant shortcomings in the diagnosis and management of CKD-3 in Italian GP. There is an urgent need to promote targeted training for GPs and to strengthen CKD early detection and care.
METHODS: A national cohort study was conducted using the Italian THIN® database to identify kidney disease-naïve individuals with an estimated glomerular filtration rate (eGFR) indicative of CKD-3 (30-59 mL/min/1.73 m²). Rates of repeat serum creatinine testing after ≥90 days, nephrology referrals, and diagnosis confirmation were assessed. Poisson regression models estimated factors associated with each outcome.
RESULTS: Among 347,548 eligible individuals, 18,002 had an eGFR indicative of CKD-3; only 8.3% were concurrently tested for urinary albumin-to-creatinine ratio, with 479 showing values ≥30 mg/g. In this subgroup, 67.6% received a second creatinine test and 12.9% were referred to a nephrologist. In the overall population, older patients (prevalence ratio [PR] 1.24; 95% CI: 1.08-1.41), males (PR 1.05; 1.03-1.08), individuals with hypertension (PR 1.05; 1.01-1.09), cardiovascular diseases (PR 1.07; 1.04-1.11), or HbA1c >6.5% (PR 1.09; 1.04-1.13) were more likely to undergo repeat creatinine testing. Referral to nephrology care was less likely with increasing age but more common among males (PR 1.76; 1.60-1.94), individuals with hypertension (PR 1.25; 1.07-1.47), diabetes (PR 1.53; 1.35-1.72), elevated albuminuria (PR 1.42; 1.12-1.81), high uric acid levels (PR 1.53; 1.28-1.82), NSAID use (PR 1.13; 1.01-1.26), or diuretic use (PR 1.45; 1.31-1.61). Diagnosis confirmation was more likely in the presence of cardiovascular disease (PR 1.13; 1.04-1.23), HbA1c >6.5% (PR 1.19; 1.07-1.32), and diuretic use (PR 1.34; 1.24-1.44).
CONCLUSIONS: The study highlights significant shortcomings in the diagnosis and management of CKD-3 in Italian GP. There is an urgent need to promote targeted training for GPs and to strengthen CKD early detection and care.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HSD74
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care, Real World Data & Information Systems
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Urinary/Kidney Disorders