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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (5): 1056-封三. doi: 10.19723/j.issn.1671-167X.2022.05.036

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Chronic kidney disease in community: Current state for screening and management

Ling-yi XU1,2,Miao HUI1,2,Shu-hong ZHU2,3,Zhao YANG1,2,Meng-rui LI1,2,Hong-yu YANG1,2,Xi-zi ZHENG1,2,Ji-cheng LV1,2,*(),Li YANG1,2,*()   

  1. 1. Renal Division, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences; Beijing 100034, China
    2. Joint Laboratory of Community Intelligent Health Management, Beijing 10034, China
    3. Health Intelligence Research Center of Beijing Xicheng District, Beijing 100053, China
  • Received:2022-06-22 Online:2022-10-18 Published:2022-10-14
  • Contact: Ji-cheng LV,Li YANG E-mail:jichenglv75@gmail.com;li.yang@bjmu.edu.cn
  • Supported by:
    the Beijing Outstanding Young Scientist Program(BJJWZYJH01201910001006);the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(2020-JKCS-009);the PKU-Baidu Fund(2020BD026);the PKU-Baidu Fund(2020BD044);the Beijing Nova Program(2021051);the CAMS Innovation Fund for Medical Sciences(2019-I2M-5-046);the Capital's Funds for Health Improvement and Research(首发2022-1-4071)

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Abstract:

Objective: To understand the current state and problem of screening and management of chronic kidney disease (CKD) in the community, and to explore the improving strategies. Methods: We established a community-CKD integrated data science platform based on medical information from 79 community health centers, in Xicheng District, Beijing. Patients who referred to 79 community health centers from 21 June 2015 to 20 November 2021 were retrospectively included in this study using the CKD data platform. The monitoring of the indicator of kidney injury, risk factor control, medicine use and device configuration in community were assessed in the study. Results: In the study, 70.6% of the population were identified with high risk of CKD in the total 374 498 individuals who referred to the community health centers. Hypertension (62.3%), coronary heart disease (43.3%) and diabetes (30.4%) were the most common risk factors in high-risk CKD population. Only 17.2% of the patients with high risk of CKD were screened for kidney injury including at least one serum creatine (Scr) or albuminuria test, among which 10 992 (24.2%) individuals were defined as CKD. 22.7% (11 338/49 908) of the total patients with kidney screening in community were defined as CKD, of whom, 42.6% and 46.1% were identified by estimated glomerular filtration rate (eGFR) < 60 mL/(min·1.73 m2) and abnormalities of urinary proteins, respectively. The overall CKD detection rate in the community was 5.2% (19 299/374 498), and the miss-diagnosis rate of CKD was 38.1%. Of the 79 community health centers, 13 (16.5%) were equipped with ACR testing device, and eGFR was reported directly in 66 (83.5%) centers. Altogether 60.3% and 99.7% of the community CKD patients achieved glucose control and blood pressure control, respectively, and 59.3% of the CKD patients who had proteinuria was treated with renin-angiotensin-aldosterone system (RAAS) inhibitors. Conclusion: High-risk CKD population account for a substantial proportion of patients who refer to the community. Early screening, prevention and management of CKD in the community are of great importance to improve the prognosis and decrease the burden of CKD. It's essential to establish a screening and monitoring system, strengthen standardized management and clinician training for improving the ability of CKD management in the community.

Key words: Chronic kidney disease, Community health services, Disease management, Health education

CLC Number: 

  • R692

Figure 1

Flow diagram of 374 498 patients in 79 community health centers CKD, chronic kidney disease."

Table 1

Baseline characteristics of high-risk and CKD patients in community health centers"

Items Total population(n=374 498) High-risk patients(n=264 514) CKD patients(n=19 299)
Male 159 320 (42.5) 120 242 (45.5) 8 925 (46.2)
Age/years 58±16 65±12 67±12
BMI/(kg/m2) 24 (22, 26) 24 (23, 27) 25 (23, 27)
Insurance 304 951 (81.4) 229 141 (86.6) 18 228 (94.5)
Diabetes 80 455 (21.5) 80 455 (30.4) 9 788 (50.7)
Hypertension 164 851 (44.0) 164 851 (62.3) 15 719 (81.4)
MI 64 (0) 64 (0) 12 (0.1)
CHD 114 662 (30.6) 114 662 (43.3) 13 101 (67.9)
HF 1 966 (0.5) 1 966 (0.7) 344 (1.8)
COPD 3 333 (0.9) 3 213 (1.2) 514 (2.7)
Cancer 4 606 (1.2) 4 606 (1.7) 470 (2.4)
Follow-up/years 1.9±1.6 2.3±1.5 3.4±1.4

Figure 2

Distribution of risk factor of comorbidity in high-risk CKD population in community CKD, chronic kidney disease; CHD, coronary heart disease; HT, hypertension; DM, diabetes mellitus."

Figure 3

Detection rate of CKD in high-risk CKD population in community CKD, chronic kidney disease; Non-CKD, high-risk patients without CKD; New CKD, CKD occurred after identified as a high-risk group; Old CKD, CKD has occurred when identified as a high-risk group."

Table 2

Evaluating of risk factors and complications of CKD patients  n (%) "

Items Total CKD patients (n=19 299) CKD patients diagnosed by ICD-10 (n=11 945)
Detection rate Control rate Detection rate Control rate
Blood glucose 5 372 (27.8) 3 240 (60.3) 2 012 (16.8) 1 253 (62.3)
Blood pressure 19 191 (99.4) 19 128 (99.7) 11 903 (99.6) 11 900 (100.0)
  SBP 19 191 (99.4) 18 720 (97.5) 11 903 (99.6) 11 787 (99.0)
  DBP 19 191 (99.4) 19 025 (99.1) 11 903 (99.6) 11 864 (99.7)
Hyperkalemia 7 719 (40.0) 154 (2.0) 2 850 (23.9) 81 (2.8)
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