Underdiagnosis of CKD in Patients With Hypertension and Cardiovascular Disease

Chronic kidney disease is under-recognized in the United States and represents a growing public health concern. Recommendations from Kidney Disease: Improving Global Outcomes call for screening for CKD in patients in high-risk groups, including those with hypertension and those with cardiovascular diseases. Early diagnosis of CKD and active management can slow progression and improve outcomes.

According to Navdeep Tangri and colleagues, there are few data available on the prevalence of undiagnosed early-stage CKD in patients with comorbidities other than type 2 diabetes. The researchers performed an analysis to examine the prevalence of undiagnosed stage CKD in patients with hypertension and cardiovascualr disease in the absence of type 2 diabetes. Results were reported during a poster session at the American Society of Nephrology Kidney Week 2023 in a poster titled Undiagnosed Early CKD in Patients With Hypertension and Cardiovascular Disease in the United States.

The analysis utilized data from the US TriNetX database. Eligible patients were ≥18 years of age and had two consecutive measurements of estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m² and <60 mL/min/1.73 m² recorded 91 to 730 days apart between 2015 and 2020.

Undiagnosed CKD was defined as the absence of an International Classification of Diseases, Ninth/Tenth Revisions (ICD 9/10) diagnosis code for CKD any time before and up to 6 months following the second eGFR (index date). The analysis cohorts included patients with the following at or before index: (1) hypertension ICD 9/10 diagnosis code but not for type 2 diabetes; (2) hypertension or atherosclerotic cardiovascular disease ICD 9/10 code but not for type 2 diabetes; (3) hypertension or heart failure ICD 9/10 diagnosis code but not for type 2 diabetes; and (4) ICD 9/10 diagnosis code for type 2 diabetes.

Among patients without type 2 diabetes, the proportion of undiagnosed stage 3 CKD in was 68.4% in patients with hypertension (95% CI, 68.2%-68.7%). Proportions were similar in patients with either hypertension or ASCVD (68.7%; 95% CI, 68.4%-69.0%) and with hypertension or heart failure (68.6%; 95% CI, 68.3%-68.8%). Those proportions were greater than those with undiagnosed CKD stage 3 and type 2 diabetes (51.7%; 95% CI, 51.3%-52.0%).

In conclusion, the authors said, “A high prevalence of undiagnosed CKD in patients with existing hypertension and cardiovascualr disease in the absence of type 2 diabetes was observed in a large contemporary US database. These results highlight an opportunity to increase early identification of CKD in people with high-risk comorbidities other than type 2 diabetes in order to implement targeted evidence-based therapies to slow progression of CKD and improve patient outcomes.”

Source: Tangri N, Kushner PR, Barone S, Arnold M, Chen H, Alvarez CS. Undiagnosed early CKD in patients with hypertension and cardiovascular disease in the United States. TH-PO1004. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2023; November 2, 2023; Philadelphia, Pennsylvania. Funding was provided by AstraZeneca plc.