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

Bénédicte Né Dicte Stengel (1) , Daniel Muenz (2) , Charlotte Tu (2) , Elodie Speyer (1) , Natalia Alencar de Pinho (1) , Christian Combe (3, 4) , Kunihiro Yamagata (5) , Helmut Reichel , Danilo Fliser (6) , Ziad André Massy (1, 7) , Antônio Alberto Lopes (8) , Michel Y. Jadoul (9) , Wolfgang C. Winkelmayer (10) , Ronald L. Pisoni (2) , Bruce M. Robinson (2) , Roberto Pecoits-Filho (2, 11)

1 CESP - Centre de recherche en épidémiologie et santé des populations
2 Arbor Research Collaborative for Health
3 CHU Bordeaux
4 BIOTIS - Bioingénierie tissulaire
5 Université de Tsukuba = University of Tsukuba
6 SUMC - Saarland University Medical Center [Homburg, Germany]
7 Hôpital Ambroise Paré [AP-HP]
8 UFBA - Universidade Federal da Bahia
9 UCL - Université Catholique de Louvain = Catholic University of Louvain
10 BCM - Baylor College of Medicine
11 PUCPR - Pontifícia Universidade Católica do Paraná [Curitiba, Brasil] = Pontifical Catholic University of Paraná [Curitiba, Brazil] = Université catholique pontificale du Paraná [Curitiba, Brésil]

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.

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

Domaines: Urologie et Néphrologie

Bénédicte Né Dicte Stengel, Daniel Muenz, Charlotte Tu, Elodie Speyer, Natalia Alencar de Pinho, et al.. Adherence to the Kidney Disease: Improving Global Outcomes CKD Guideline in Nephrology Practice Across Countries. Kidney International Reports, 2021, 6 (2), pp.437-448. ⟨10.1016/j.ekir.2020.11.039⟩. ⟨hal-03162107⟩