An exploration of under-registration of chronic kidney disease stages 3-5 in Belgian general practices using logistic regression

Ine Van den Wyngaert; Pavlos Mamouris; Bert Vaes; Gijs Van Pottelbergh

doi:10.1371/journal.pone.0279291

An exploration of under-registration of chronic kidney disease stages 3-5 in Belgian general practices using logistic regression

PLoS One. 2022 Dec 22;17(12):e0279291. doi: 10.1371/journal.pone.0279291. eCollection 2022.

Authors

Ine Van den Wyngaert¹, Pavlos Mamouris¹, Bert Vaes¹, Gijs Van Pottelbergh¹

Affiliation

¹ Academic Centre for General Practice, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium.

Abstract

Background: Early detection and treatment of chronic kidney disease (CKD) can prevent further deterioration and complications. Previous studies suggested that the diagnosis is often made when advanced renal failure occurs. The aims of this study were to describe the prevalence of unregistered CKD stages 3-5 in a Belgian General Practitioner population, to determine risk factors for under-registration and to investigate the diagnostic delay.

Methods: The analyses were carried out in the INTEGO database, a Flanders general practice-based morbidity registration network. The study used INTEGO data from the year 2018 for all patients ≥18 years old. CKD was defined as two consecutive eGFR laboratory measurements (eGFR <60 mL/min/1.73m2) at least three months apart during the baseline period. Registered CKD was characterised by a documented diagnosis of CKD (ICPC2 U99) during the ≥12-month lookback period before the first eGFR measurement and up to six months after the second eGFR in the EHR. The prevalence of unregistered CKD and the median time of diagnostic delay were estimated. Baseline characteristics were described. A multivariate cross-sectional logistic regression analysis was conducted to identify determinants of unregistered CKD. We estimated the odds ratios and their 95% confidence interval.

Results: Among included patients, there were 10 551 patients (5.5%) meeting the criteria of CKD. The prevalence of unregistered CKD was 68%. The mean diagnostic delay was 1.94 years (Standard deviation 0.93). Being a male, a concurrent diagnosis of diabetes, stroke, heart failure and hypertension, and more severe CKD (stages 3b, 4 and 5) independently increased the chance on registered CKD.

Conclusion: The proportion of patients who had no registered CKD code in the EHR was substantial. The differences between registered and unregistered patients make thinking about solutions to facilitate registration in the EHR imperative.

Copyright: © 2022 Van den Wyngaert et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Belgium / epidemiology
Cross-Sectional Studies
Delayed Diagnosis
General Practice*
Glomerular Filtration Rate
Humans
Logistic Models
Male
Prevalence
Renal Insufficiency, Chronic* / complications
Renal Insufficiency, Chronic* / diagnosis
Renal Insufficiency, Chronic* / epidemiology
Risk Factors

Grants and funding

- This study was funded by AstraZeneca BeLux (https://www.astrazeneca.be/). - AstraZeneca discussed the study design, but did not play a role in the data collection, data analysis, decision to publish or preparation of the manuscript. - The grant was given to the research group, not to an individual author.