QJM Advance Access originally published online on January 9, 2008
QJM 2008 101(2):91-97; doi:10.1093/qjmed/hcm130
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Prevalence of chronic kidney disease stages 3–5 among acute medical admissions: another opportunity for screening
From the 1Department of Renal Medicine and Transplantation and 2Department of Information and Computing, St Georges Hospital, London, SW17 0QT, UK
Address correspondence to Dr Debasish Banerjee, Department of Renal Medicine and Transplantation, St Georges Hospital, London SW17 0QT, UK. email: debasish.banerjee{at}stgeorges.nhs.uk
Received 17 July 2007 and in revised form 20 August 2007
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Abstract |
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Background: Early identification of chronic kidney disease (CKD) can help delay or prevent its progression, but the opportunities for systematic screening of patients are not well defined.
Aim: To define the prevalence of CKD Stages 3–5 and related anaemia among acute medical admissions.
Design: Retrospective analysis.
Methods: We studied all acute medical admissions to a major London teaching hospital during one year. The lowest creatinine, highest haemoglobin (Hb) and average mean corpuscular volume (MCV) were determined for 3 months before and after admission. Patients were categorized as CKD Stages 3–5 if the highest estimated GFR (eGFR) was <60 ml/min/1.73 m2. CKD-related anaemia was diagnosed if these patients had Hb <11 g/dl with normal MCV.
Results: A total of 6073 patients were studied: male 49.0%, age 65.4 ± 19.6 years (mean ± SD), creatinine 82.7 ± 46.7 µmol/l, eGFR 89.1 ± 32.5 ml/min/1.73 m2, Hb 13.6 ± 1.73 g/dl, MCV 87.7 ± 7.2 fl. There was an inverse correlation between eGFR and age (r2 = 0.5; P < 0.001). Males were younger than females (63.5 ± 18.4 years vs. 67.3 ± 20.5) and had higher eGFR (93.6 ± 34.1 vs. 84.7 ± 30.2 ml/min/1.73 m2; P < 0.001). A total of 743 patients (12.2%) had raised creatinine >110 µmol/l, however using eGFR <60 ml/min/1.73 m2, 1075 patients (17.7%) were identified. The patients were categorized as follows: Stage 3: 950 (15.6%), Stage 4: 100 (1.7%), Stage 5: 25 (0.4%). Ninety-nine (9.2%) of the 1075 patients had normocytic anaemia.
Conclusions: We have found a high prevalence of CKD Stages 3–5 (17.7%) among acute medical admissions, of whom 9.2% had a related anaemia. Our findings highlight an important opportunity (amongst the 1.9 million acute medical admissions annually in England) for detecting patients with CKD.