CHRONIC kidney disease (CKD) affected almost one-third of internal medicine outpatients at a Central European tertiary care centre, while gaps in renoprotective treatment highlighted opportunities to improve disease management. The cross-sectional observational study assessed CKD prevalence, associated risk factors, screening outcomes, and the use of therapies intended to protect kidney function.
Researchers screened 1,933 adult outpatients at risk of CKD and included an expanded cohort of 2,903 patients with available laboratory data for secondary analyses. Kidney function was assessed using eGFR and urine albumin-to-creatinine ratio (uACR), in accordance with Kidney Disease: Improving Global Outcomes criteria.
The prevalence of CKD was 32.5% (95% credible interval: 30.5–34.6) and remained high after applying age-calibrated eGFR thresholds. Screening also identified previously unrecognised disease, with one new case detected for every 5.2 patients screened. These findings indicated that targeted assessment could help identify CKD among patients attending specialist outpatient services.
The analysis identified several clinical characteristics associated with higher odds of CKD. Age was a prominent factor, with the odds increasing 3.81-fold for every 25-year increase in age (95% credible interval: 3.09–4.67).
Other associations included non-renal transplantation (odds ratio: 4.38; 95% credible interval: 3.30–5.84), hypertension (odds ratio: 2.61; 95% credible interval: 1.96–3.54), and heart failure or atrial fibrillation (odds ratio: 1.59; 95% credible interval: 1.29–1.96). Type 1 diabetes, Type 2 diabetes, and atherosclerotic disease were also associated with increased odds of CKD.
These findings highlighted the importance of considering kidney health in patients with cardiovascular conditions, diabetes, and other clinical risk factors.
Despite the high disease burden, uptake of renoprotective therapies remained suboptimal among eligible patients. Sodium-glucose co-transporter-2 inhibitors were prescribed to 42% of eligible patients, while glucagon-like peptide-1 receptor agonists were used by 41.7%. Non-steroidal mineralocorticoid receptor antagonists were used by just 6.7%.
An exploratory model projected that initiating renoprotective treatment could provide an average gain of 11.13 months in dialysis-free time per patient with CKD. This estimate was model-based rather than an observed clinical outcome.
The researchers concluded that CKD was highly prevalent and could be detected efficiently through targeted screening. Further research should investigate implementation strategies to improve the uptake of renoprotective therapies and address the treatment gap identified in this outpatient population.
Zahradka I et al. Prevalence, risk factors and renoprotective treatment of chronic kidney disease among internal medicine outpatients at a Central European tertiary care centre: a cross-sectional study. BMJ Open. 2026;16(10):e121190.
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