The Prevalence of CKD in Australian Primary Care: Analysis of a National General Practice Dataset

Min Jun; James Wick; Brendon L Neuen; Sradha Kotwal; Sunil V Badve; Mark Woodward; John Chalmers; David Peiris; Anthony Rodgers; Kellie Nallaiah; Meg J Jardine; Vlado Perkovic; Martin Gallagher; Paul E Ronksley

doi:10.1016/j.ekir.2023.11.022

The Prevalence of CKD in Australian Primary Care: Analysis of a National General Practice Dataset

Kidney Int Rep. 2023 Nov 29;9(2):312-322. doi: 10.1016/j.ekir.2023.11.022. eCollection 2024 Feb.

Authors

Min Jun^{1

2}, James Wick³, Brendon L Neuen¹, Sradha Kotwal^{1

4}, Sunil V Badve^{1

5}, Mark Woodward^{1

6}, John Chalmers¹, David Peiris¹, Anthony Rodgers¹, Kellie Nallaiah¹, Meg J Jardine⁷, Vlado Perkovic², Martin Gallagher^{1

8}, Paul E Ronksley^{9

10}

Affiliations

¹ The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia.
² Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia.
³ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁴ Prince of Wales Hospital, University of New South Wales, Sydney, New South Wales, Australia.
⁵ Department of Renal Medicine, St George Hospital, Sydney, New South Wales, Australia.
⁶ The George Institute for Global Health, School of Public Health, Imperial College London, London, UK.
⁷ NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
⁸ Liverpool Clinical School, University of New South Wales Sydney, Sydney, New South Wales, Australia.
⁹ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹⁰ O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Abstract

Introduction: The prevalence of chronic kidney disease (CKD) in Australia varies substantially across reports. Using a large, nationally representative general practice data source, we determined the contemporary prevalence and staging of CKD in the Australian primary care.

Methods: We performed a retrospective, community-based observational study of 2,720,529 adults with ≥1 visit to a general practice participating in the MedicineInsight program and ≥1 serum creatinine measurement (with or without a urine albumin-to-creatinine ratio [UACR] measurement) between 2011 and 2020. CKD prevalence was estimated using 3 definitions based on estimated glomerular filtration rate (eGFR) and UACR measurements with varying degrees of rigidity in terms of the number of measurements assessed to define CKD ("least", "moderate" and "most" rigid).

Results: CKD prevalence in the cohort progressively increased over the 10-year study period, irrespective of the method used to define CKD. In 2020, CKD prevalence in the cohort was 8.4%, 4.7%, and 3.1% using the least, moderate, and most rigid definition, respectively. The number of patients with UACR measurements was low such that, among those with CKD in 2020, only 3.8%, 3.2%, and 1.5%, respectively, had both eGFR and UACR measurements available in the corresponding year. Patients in whom both eGFR and UACR measurements were available mostly had moderate or high risk of CKD progression (83.6%, 80.6%, and 76.2%, respectively).

Conclusion: In this large, nationally representative study, we observed an increasing trend in CKD prevalence in primary care settings in Australia. Most patients with CKD were at moderate to high risk of CKD progression. These findings highlight the need for early detection and effective management to slow progression of CKD.

Keywords: UACR; chronic kidney disease; eGFR; epidemiology; prevalence; primary care.