Screening and management of hypertensive patients with chronic kidney disease referred to Hypertension Excellence Centres among 27 countries. A pilot survey based on questionnaire
Authors: Halimi Jean-Michel , Sarafidis Pantelis , Azizi Michel , Bilo Grzegorz , Burkard Thilo , Bursztyn Michael , Camafort Miguel , Chapman Neil , Cottone Santina , de Backer Tine , Deinum Jaap , Delmotte Philippe , Dorobantu Maria , Doumas Michalis , Dusing Rainer , Duly-Bouhanick Béatrice , Fauvel Jean-Pierre , Fesler Pierre , Gaciong Zbigniew , Gkaliagkousi Eugenia , Gordin Daniel , Grassi Guido , Grassos Charalampos , Guerrot Dominique , Huart Justine , Izzo Raffaele , Águila Fernando Jaén , Járai Zoltán , Kahan Thomas , Kantola Ilkka , Kociánová Eva , Limbourg Florian P. , Lopez-Sublet Marilucy , Mallamaci Francesca , Manolis Athanasios , Marketou Maria , Mayer Gert , Mazza Alberto , MacIntyre Iain M. , Mourad Jean-Jacques , Muiesan Maria Lorenza , Nasr Edgar , Nilsson Peter , Oliveras Anna , Ormezzano Olivier , Paixão-Dias Vitor , Papadakis Ioannis , Papadopoulos Dimitris , Perl Sabine , Polónia Jorge , Pontremoli Roberto , Pucci Giacomo , Robles Nicolás Roberto , Rubin Sébastien , Ruilope Luis Miguel , Rump Lars Christian , Saeed Sahrai , Sanidas Elias , Sarzani Riccardo , Schmieder Roland , Silhol François , Sokolovic Sekib , Solbu Marit , Soucek Miroslav , Stergiou George , Sudano Isabella , Tabbalat Ramzi , Tengiz Istemihan , Triantafyllidi Helen , Tsioufis Konstontinos , Václavík Jan , van der Giet Markus , Van der Niepen Patricia , Veglio Franco , Venzin Reto M. , Viigimaa Margus , Weber Thomas , Widimsky Jiri , Wuerzner Grégoire , Zelveian Parounak , Zebekakis Pantelis , Lueders Stephan , Persu Alexandre , Kreutz Reinhold , Vogt Liffert ,   the European Society of Hypertension Working Group on Hypertension, the Kidney
Published: May 2024

Objective:
Real-life management of hypertensive patients with chronic kidney disease (CKD) is unclear.

Methods:
A survey was conducted in 2023 by the European Society of Hypertension (ESH) to assess management of CKD patients referred to ESH-Hypertension Excellence Centres (ESH-ECs) at first referral visit. The questionnaire contained 64 questions with which ESH-ECs representatives were asked to estimate preexisting CKD management quality.

Results:
Overall, 88 ESH-ECs from 27 countries participated (fully completed surveys: 66/88 [75.0%]). ESH-ECs reported that 28% (median, interquartile range: 15–50%) had preexisting CKD, with 10% of them (5–30%) previously referred to a nephrologist, while 30% (15–40%) had resistant hypertension. The reported rate of previous recent (<6 months) estimated glomerular filtration rate (eGFR) and urine albumin–creatinine ratio (UACR) testing were 80% (50–95%) and 30% (15–50%), respectively. The reported use of renin-angiotensin system blockers was 80% (70–90%). When a nephrologist was part of the ESH-EC teams the reported rates SGLT2 inhibitors (27.5% [20–40%] vs. 15% [10–25], P = 0.003), GLP1-RA (10% [10–20%] vs. 5% [5–10%], P = 0.003) and mineralocorticoid receptor antagonists (20% [10–30%] vs. 15% [10–20%], P = 0.05) use were greater as compared to ESH-ECs without nephrologist participation. The rate of reported resistant hypertension, recent eGFR and UACR results and management of CKD patients prior to referral varied widely across countries.

Conclusions:
Our estimation indicates deficits regarding CKD screening, use of nephroprotective drugs and referral to nephrologists before referral to ESH-ECs but results varied widely across countries. This information can be used to build specific programs to improve care in hypertensives with CKD.