The management of chronic kidney disease in primary care in Denmark: patient characteristics, treatment, follow-up, progression and referral

BACKGROUND: Chronic kidney disease (CKD) is mainly managed in primary care, but detailed information on these patients is limited. This study describes CKD patients and the disease management and referrals by general practitioners (GPs) in Denmark in order to identify opportunities for improved care.

METHODS: Patients with CKD, defined by at least two abnormal estimated glomerular filtration rate (eGFR) or urinary albumin/creatinine ratio (UACR) measurements ≥90 days apart during 2019-2020, were followed until May 2023 utilizing electronic health records.

RESULTS: Among 1316 patients with one abnormal eGFR or UACR test, 993 (75%) had a second abnormal test within a median of 10.8 months, which confirmed CKD. Most patients (62%) were G-stage 3a, 89% had cardiovascular disease and 34% had diabetes. A UACR test was performed in 52% of patients around time of index. The use of renin-angiotensin-aldosterone system inhibitors was high (67%), whereas sodium-glucose cotransporter 2 inhibitors was low at inclusion (5%), although increasing during follow-up (15%). Patients had a median of 13.5 GP contacts/year, 1-2 eGFR and 0-1 UACR tests/year, and only 2.7% were referred to a nephrologist. The median decline in eGFR was modest; however, 15% experienced a drop of >5.0 mL/min/1.73 m2 during 3-years of follow-up.

CONCLUSIONS: The findings indicate a high likelihood of CKD following one abnormal measurement. CKD patients constitute a significant burden to primary care with frequent GP contacts, yet more focus on UACR testing and new treatment adaptation to improve CKD prognosis is warranted.