Minutolo Roberto, De Nicola Luca, Mazzaglia Giampiero, Postorino Maurizio, Cricelli Claudio, Mantovani Lorenzo G, Conte Giuseppe, Cianciaruso Bruno
Department of Nephrology, Second University of Naples, Naples, Italy.
Am J Kidney Dis. 2008 Sep;52(3):444-53. doi: 10.1053/j.ajkd.2008.03.002. Epub 2008 May 12.
Chronic kidney disease (CKD) is a strong independent predictor of cardiovascular disease. Although general practitioners (GPs) represent the first line for identification of these high-risk patients, their diagnostic approach to CKD is ill defined.
Cross-sectional evaluation of database of Italian GPs.
SETTING & PARTICIPANTS: Representative sample of adult Italian population regularly followed up by GPs in 2003.
Frequency of serum creatinine testing, prevalence of CKD (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m(2)), awareness of CKD assessed from use of diagnostic codes (Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]) for CKD, and referral to nephrologists.
Of 451,548 individuals in the entire practice population, only 77,630 (17.2%) underwent serum creatinine testing. Female sex (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.06 to 1.12), advanced age (OR, 2.70; 95% CI, 2.63 to 2.78), diabetes (OR, 1.31; 95% CI, 1.20 to 1.42), hypertension (OR, 1.10; 95% CI, 1.02 to 1.19), autoimmune diseases (OR, 1.42; 95% CI, 1.11 to 1.82), and recurrent urinary tract infections (OR, 1.63; 95% CI, 1.10 to 2.42) were all associated with serum creatinine testing. Conversely, use of either nonsteroidal anti-inflammatory drugs (OR, 1.03; 95% CI, 0.89 to 1.21) or aminoglycosides or contrast media (OR, 0.78; 95% CI, 0.54 to 1.14) was not associated with serum creatinine testing. In the subgroup with serum creatinine data, the age-adjusted prevalence of CKD was 9.33% (11.93% in women, 6.49% in men). However, in patients with eGFR less than 60 mL/min/1.73 m(2), serum creatinine values were apparently normal (<1.2 mg/dL in women, <1.4 mg/dL in men) in 54%, and GPs used ICD-9-CM codes for CKD in only 15.2%. Referral to nephrologists ranged from 4.9% for patients with eGFR of 59 to 30 mL/min/1.73 m(2) to 55.7% for those with eGFR less than 30 mL/min/1.73 m(2).
The prevalence of decreased kidney function may be overestimated because of the more frequent serum creatinine testing in sicker individuals and lack of creatinine calibration.
In primary care, CKD stages 3 to 5 are frequent, but its awareness is scarce because of limited rates of serum creatinine testing and difficulty recognizing decreased eGFR in the absence of increased serum creatinine testing.
慢性肾脏病（CKD）是心血管疾病的一个强有力的独立预测因素。尽管全科医生（GPs）是识别这些高危患者的第一线，但他们对CKD的诊断方法尚不明确。
对意大利全科医生数据库进行横断面评估。
2003年由全科医生定期随访的意大利成年人群的代表性样本。
在整个执业人群的451,548人中，只有77,630人（17.2%）进行了血清肌酐检测。女性（比值比[OR]，1.09；95%置信区间[CI]，1.06至1.12）、高龄（OR，2.70；95%CI，2.63至2.78）、糖尿病（OR，1.31；95%CI，1.20至1.42）、高血压（OR，1.10；95%CI，1.02至1.19）、自身免疫性疾病（OR，1.42；95%CI，1.11至1.82）以及复发性尿路感染（OR，1.63；95%CI，1.10至2.42）均与血清肌酐检测相关。相反，使用非甾体抗炎药（OR，1.03；95%CI，0.89至1.21）或氨基糖苷类药物或造影剂（OR，0.78；95%CI，0.54至1.14）与血清肌酐检测无关。在有血清肌酐数据的亚组中，年龄调整后的CKD患病率为9.33%（女性为11.93%，男性为6.49%）。然而，在估算肾小球滤过率（eGFR）低于60 mL/min/1.73 m²的患者中，54%的患者血清肌酐值明显正常（女性<1.2 mg/dL，男性<1.4 mg/dL），而全科医生仅在15.2%的患者中使用了CKD的国际疾病分类第九版临床修订本（ICD-9-CM）编码。转诊至肾病科医生的比例从eGFR为59至30 mL/min/1.73 m²的患者中的4.9%到eGFR低于30 mL/min/1.73 m²的患者中的55.7%不等。
由于病情较重的个体血清肌酐检测更频繁且缺乏肌酐校准，肾功能下降的患病率可能被高估。
在初级保健中，CKD 3至5期很常见，但由于血清肌酐检测率有限以及在血清肌酐检测未增加的情况下难以识别eGFR降低，对其的认知较少。
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