Kidney disease hiding in plain sight in General Practice

Despite rising rates of chronic kidney disease (CKD) in Australia, new research suggests GPs are missing critical opportunities for early diagnosis and intervention.

In a large-scale study led by University of Melbourne researchers, just 28.1% of primary care patients with pathology-confirmed CKD had the diagnosis formally recorded in their medical records.

“Our study revealed that there are challenges across the span of CKD spectrum from screening to diagnosis and management. The findings also suggest that CKD identification, diagnosis and management in Australian general practice remains a largely passive process, rather than one of active surveillance,” the authors wrote.

The findings point to widespread under-recognition, with only 54% of patients receiving follow-up eGFR testing within six months of an initial abnormal result. Rates of follow-up albumin-creatinine ratio (ACR) testing were even lower at 28.8%. Notably, fewer than 20% of patients received both tests, highlighting missed opportunities for detecting progressive CKD at an earlier, more manageable stage.

Screening among patients with CKD risk factors such as hypertension or diabetes was also variable. While 76.1% had an eGFR recorded in the final 18 months of the five-year study, just 34.2% underwent an ACR test. In patients with established CKD, 85% had an eGFR monitored, but only 43.6% had an ACR performed.

Blood pressure monitoring was completed for 71.1% of patients with CKD within the previous nine months, and in 75.6% of those with both diabetes and albuminuria. However, just 45% of patients had blood pressure levels within guideline-recommended targets.

“These findings are concerning, given the increasing prevalence of CKD in Australian general practice, most of which are associated with a moderate or high risk of CKD progression. As such, appropriate monitoring and management to reduce the risk of CKD progression and associated CVD is critical,” the authors emphasised.

Amid the concerning gaps in testing and diagnosis, one area showed promise. The use of pharmacological interventions was relatively high, particularly among high-risk groups.

“The high rate of prescribing of renin angiotensin aldosterone system (RAAS) inhibitors, including ACE inhibitors and ARBs, in patients with CKD, diabetes and albuminuria (68.7%) is encouraging. These medications are recommended in both national and international guidelines for their role in slowing CKD progression, reducing albuminuria, and lowering cardiovascular risk,” said the authors.

With three-quarters of Australians facing the risk of kidney disease and 2.7 million showing signs of the condition, the study emphasises the critical importance of proactive monitoring by GPs. It calls for wider adoption of recommended screening tests and a sustained focus on early detection to curb the one in six hospitalisations attributed to this disease.

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