Early detection of chronic kidney disease: collaboration of Belgrade nephrologists and primary care physicians.

BACKGROUND: Belgrade screening study was undertaken in order to detect persons with CKD markers in at risk populations and to educate primary care physicians how to carry out CKD screening. METHODS: The study was performed by primary care physicians from thirteen Belgrade health centers in collaboration with nephrologists from clinical centers. Subjects without previously known kidney disease were enrolled: 1316 patients with hypertension without diabetes, 208 patients with type 2 diabetes and 93 subjects older than 60 years without hypertension or diabetes. The survey consisted of an interview, consisted of an interview, estimation of glomerular filtration rate (eGFR-MDRD), single urine dipstick detection of proteinuria, hematuria, glucosuria, microalbuminuria. RESULTS: Microalbuminuria with or without proteinuria in combination with eGFR>60 ml/min/1.73 m2 was detected in 17% , 41% and 24% of patients with hypertension, diabetes and those above 60 years, respectively. Reduced eGFR (<60 ml/min/1.73 m2 ) was found in 23%, 12% and 22% of the same patient groups. The prevalence of CKD markers increased with increasing number of risk factors. CONCLUSION: High prevalence of CKD markers in at risk population detected by primary care physicians in this collaborative study seems to be the best way to encourage primary care physicians to carry out regular CKD screening.

Early detection of chronic kidney disease: Collaboration of Belgrade nephrologists and primary care physicians

Background: Belgrade screening study was undertaken in order to detect persons with CKD markers in at risk populations and to educate primary care physicians how to carry out CKD screening. Methods: The study was performed by primary care physicians from thirteen Belgrade health centers in collaboration with nephrologists from clinical centers. Subjects without previously known kidney disease were enrolled: 1316 patients with hypertension without diabetes, 208 patients with type 2 diabetes and 93 subjects older than 60 years without hypertension or diabetes. The survey consisted of an interview, consisted of an interview, estimation of glomerular filtration rate (eGFR-MDRD), single urine dipstick detection of proteinuria, hematuria, glucosuria, microalbuminuria. Results: Microalbu minuria with or without proteinuria in combination with eGFR>60 ml/min/1.73m2 was detected in 17% , 41% and 24% of patients with hypertension, diabetes and those above 60 years, respectively. Reduced eGFR (<60 ml/min/1.73m2 ) was found in 23%, 12% and 22% of the same patient groups. The prevalence of CKD markers increased with increasing number of risk factors. Conclusion: High prevalence of CKD markers in at risk population detected by primary care physicians in this collaborative study seems to be the best way to encourage primary care physicians to carry out regular CKD screening (AU)

Antecedentes: El estudio de Belgrado se realizó para detectar personas con marcadores de ERC en poblaciones de riesgo y formar a los especialistas de atención primaria sobre cómo realizar proyecciones de ERC. Métodos: El estudio fue realizado por especialistas de atención primaria de trece centros de salud en colaboración con nefrólogos de centros clínicos. Se incluyó a personas sin enfermedad renal previa conocida: 1316 pacientes con hipertensión sin diabetes, 208 pacientes con diabetes tipo 2 y 93 pacientes de más de 60 años sin hipertensión ni diabetes. El estudio consistía en una entrevista, determinación de la tasa de filtración glomerular estimada (TFGe-MDRD) y detección de proteinuria, hematuria, glucosuria y microalbuminuria con una única tira reactiva de orina. Resultados: Se detectó microalbuminuria con o sin proteinuria en combinación con una TFGe >60 ml/min/1,73m2 en el 17%, el 41% y el 24% de los pacientes con hipertensión, diabetes y mayores de 60 años, respectivamente. Se encontró una TFGe reducida (<60 ml/min/1,73m2 ) en el 23%, el 12% y el 22% de estos mismos grupos de pacientes. La prevalencia de los marcadores de ERC aumentaba cuanto mayor era el número de factores de riesgo. Conclusión: La elevada prevalencia de marcadores de ERC en una población de riesgo detectada por los médicos de atención primaria en este estudio de colaboración parece ser la mejor forma de motivar a estos especialistas para que realicen cribados de ERC con regularidad (AU)

Screening of a population at risk of chronic kidney disease: analysis of factors associated with low eGFR and microalbuminuria.

BACKGROUND AND OBJECTIVE: Numerous screenings of chronic kidney disease (CKD) have been performed all over the world. This screening study was undertaken with the aim of estimating the prevalence of low glomerular filtration rate (eGFR) and microalbuminuria (MAU) and/or proteinuria in a population at risk for CKD and to detect factors associated with these CKD markers. MATERIALS AND METHODS: This cross-sectional study included 1617 patients without previously known kidney disease who came for regular check-ups to their general practitioners in 13 Belgrade health centers over a 3-month period. Patients selected were as follows: 1316 with hypertension, 208 with type 2 diabetes, and 93 older than 60 years without hypertension or diabetes. Screening included a questionnaire, blood pressure measurement, single MAU dipstick measurement (Micral-test® strip) and proteinuria and GFR estimation by Modification of Diet in Renal Disease. RESULTS: MAU was found in 419 (25.9%) patients, proteinuria in 163 (10.1%), and eGFR < 60 mL/min/1.73 m(2) in 370 (22.9%). Multivariate logistic regression analysis revealed that female gender, age, duration of hypertension, and smoking were associated with eGFR. Male gender, hypertension, treatment with angiotensin-converting enzyme inhibitors, proteinuria, and systolic blood pressure were associated with MAU. CONCLUSIONS: High prevalence of MAU/proteinuria and reduced eGFR were found in high-risk persons for CKD. Besides nonmodifiable, significant modifiable factors for MAU were use of angiotensin-converting enzyme inhibitors and strict regulation of hypertension and the factor for reduced eGFR was smoking.