Adherence to the Kidney Disease: Improving Global Outcomes CKD Guideline in Nephrology Practice Across Countries

Bénédicte Stengel; Daniel Muenz; Charlotte Tu; Elodie Speyer; Natalia Alencar de Pinho; Christian Combe; Kunihiro Yamagata; Helmut Reichel; Danilo Fliser; Ziad A Massy; Antonio A Lopes; Michel Jadoul; Wolfgang C Winkelmayer; Ronald L Pisoni; Bruce M Robinson; Roberto Pecoits-Filho; CKDopps investigators

doi:10.1016/j.ekir.2020.11.039

Adherence to the Kidney Disease: Improving Global Outcomes CKD Guideline in Nephrology Practice Across Countries

Kidney Int Rep. 2020 Dec 17;6(2):437-448. doi: 10.1016/j.ekir.2020.11.039. eCollection 2021 Feb.

Authors

Bénédicte Stengel¹, Daniel Muenz², Charlotte Tu², Elodie Speyer¹, Natalia Alencar de Pinho¹, Christian Combe^{3

4}, Kunihiro Yamagata⁵, Helmut Reichel⁶, Danilo Fliser⁷, Ziad A Massy^{1

8}, Antonio A Lopes⁹, Michel Jadoul¹⁰, Wolfgang C Winkelmayer¹¹, Ronald L Pisoni², Bruce M Robinson², Roberto Pecoits-Filho^{2

12}; CKDopps investigators

Affiliations

¹ Centre for Research in Epidemiology and Population Health, Paris-Saclay University, Versailles Saint Quentin University, INSERM UMRS 1018, Villejuif, France.
² Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
³ Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
⁴ INSERM U1026, Université Bordeaux Segalen, Bordeaux, France.
⁵ Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
⁶ Nephrological Center, Villingen-Schwenningen, Germany.
⁷ Department of Internal Medicine IV, Saarland University Medical Center, Homburg, Germany.
⁸ Department of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, France.
⁹ Department of Internal Medicine, Federal University of Bahia, Salvador, Brazil.
¹⁰ Department of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
¹¹ Section for Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas, USA.
¹² School of Medicine, Pontificia Universidade Catolica do Parana, Brazil.

Abstract

Introduction: The uptake of the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 chronic kidney disease (CKD) Guideline is not fully described in real-world nephrology practice across the world.

Methods: We used baseline data from the CKD Outcomes and Practice Patterns Study (2013-2017), a 4-country cohort of patients with estimated glomerular filtration rate <60 ml/min per 1.73 m² recruited from national samples of nephrology clinics, to describe adherence to measures for monitoring and delaying CKD progression. Data were collected as in clinical practice, except laboratory measures per protocol in France.

Results: The mean age ranged from 65 years in Brazil to 72 years in Germany. Albuminuria (mostly proteinuria) was measured routinely in 36% to 43% of patients in Brazil, Germany, and the United States. Blood pressure control (≤140/90 mm Hg) ranged from 49% in France to 76% in Brazil; <40% of patients had blood pressure ≤130/80 mm Hg everywhere but Brazil (52%). More than 40% of nephrologists in Brazil reported a systolic blood pressure target ≤130 mm Hg for nondiabetic patients without proteinuria, but only 19% to 24% elsewhere. Prescription of renin-angiotensin aldosterone system inhibitors ranged from 52% in the United States to 81% in Germany. Dietary advice was more frequent for salt than protein intake; dietitian visits were uncommon. In nondiabetic patients, achievement of all 3 targets including blood pressure ≤130/80 mm Hg, renin-angiotensin aldosterone system inhibition, and dietary advice, ranged from 10% in the United States to 32% in Brazil; in treated diabetic patients, this ranged from 6% to 11% after including hemoglobin A1c target.

Conclusion: Adherence to recommendations to slow CKD progression is low in typical practice settings, and substantial variation among countries for some indicates opportunities for improvement.

Keywords: albuminuria; blood pressure control; chronic kidney disease; dietary advice; lifestyle; renin-angiotensin system inhibition.