#487 Treating chronic kidney disease in Danish primary care: results from the observational ATLAS study
Authors: Borg Rikke , Lindhardt Morten , Saxild Thomas , Charles Morten , Knudsen Søren Tang 
Published: May 2024

Abstract

Background and Aims
Little is known about the clinical characteristics and medical treatment of individuals with chronic Kidney Disease (CKD) in primary care clinics, including uptake of cardio-renoprotective treatments like renin-angiotensin-system inhibitors (RASi) and sodium glucose co-transporter 2 inhibitors (SGLT2i).
Therefore, the aim of this study were to describe the clinical characteristics, comorbidity, and medical treatment in the primary care population with decreased estimated glomerular filtration rate (eGFR) and albuminuria. Additionally, to examine the awareness and habits of primary care physicians (PCP) in regard to CKD and treatment patterns in this high-risk patient population.

Method
An observational study of current CKD prevalence, treatment patterns and comorbidities in primary care based on patient record data, Data was drawn from 128/211 randomly invited primary care clinics throughout Denmark. A computerized selection identified 12 random individuals with CKD per clinic with ≥2 measurements of eGFR &lt;60 mL/min/1.73 m2 or UACR &gt;30 mg/g within two years. Pre-specified data collected from individual electronic health records included demographics, clinical variables, comorbidities, and relevant prescribed medications.
Our analyses was strengthened by 125/128 PCP completing a questionnaire with responses regarding diagnosis, management and treatment of impaired kidney function in a real-world, primary care setting.

Results
Of the identified CKD study population (N = 1497), 80% had hypertension, 32% diabetes (DM), 13% heart failure (HF), 59% no DM/HF. RASi were prescribed to 65%, statins to 56%, SGTL2is to 14%, and MRAs to 8% of all individuals. Treatment patterns differed between individuals with varying comorbidities, e.g., RASi usage was higher in DM (76%) or HF (74%) vs. no DM/HF (58%), as was statin usage (76% in DM vs. 45% in no DM/HF). SGTL2i usage in CKD without DM/HF was low.
Questionnaire results showed that most PCPs identified CKD using threshold eGFR &lt;60 mL/min/1.73 m2 (62%) or UACR &gt;30 mg/g (58%) and 62% reported initiating treatment to retard kidney function decline. 53% of PCPs reported using SGLT2is as second-line treatment for CKD. 38% of PCPs often spoke to patients with an eGFR &lt;60 mL/min/1.73 m2 as having CKD, whilst 38% reported rarely doing so and 19% never did so.
The voluntary nature of PCP study participation (accepting an invitation to participate) may have generated bias towards those with an interest in CKD.

Conclusion
Despite good PCP awareness and wish to use relevant guidelines, a gap exists in implementation of cardio-renoprotective treatment, especially in individuals without DM or HF. Data from both patient files and questionnaires emphasizes a need for clear recommendations to PCPs to optimize early cardio-renal protection in individuals with CKD. Applying the same systematic screening as in individuals with DM to non-diabetic populations could offer a paradigm shift for the identification, diagnosis and monitoring of CKD.
Boehringer Ingelheim supported this study, but had no role in the design, analysis or interpretation of the results.