Wallace Hannah, Wick James, Ketema Daniel Bekele, Buizen Luke, Woodward Mark, Peiris David, Neuen Brendon L, Robertson Charlotte, Nelson Craig, Chalmers John, Badve Sunil V, Kotwal Sradha S, Ronksley Paul, Gallagher Martin, Jun Min
The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia.
Western Health Chronic Disease Alliance, Victoria, Australia.
Lancet Reg Health West Pac. 2025 Apr 10;57:101541. doi: 10.1016/j.lanwpc.2025.101541. eCollection 2025 Apr.
Chronic kidney disease (CKD) monitoring and cardiovascular risk management are essential in reducing disease progression and cardiovascular events. This study aimed to understand CKD monitoring and management practices in Australian primary care.
We conducted a retrospective, population-based cohort study of adults who attended general practices participating in MedicineInsight between 1 January 2011 and 30 June 2020 and met diagnostic criteria for CKD. Care quality was assessed in the 18-months following identification of CKD. Core monitoring was defined as at least one assessment of all the following measurements: blood pressure, estimated glomerular filtration rate (eGFR), urine albumin creatinine ratio (UACR), lipid profile, and HbA1c in patients with diabetes. Cardiovascular risk management comprised medication prescription (ACEi/ARB and statin), blood pressure target achievement and LDL cholesterol <2 mmol/L. Modified Poisson regression models adjusted for socio-demographic and clinical characteristics were used to identify patient factors associated with completion of monitoring and medication prescription.
CKD was identified in 140,780 patients, of which 34.2% received core monitoring within 18 months of CKD identification. Measurement of the individual components of the core monitoring outcome varied: blood pressure (88.7%), eGFR (86.0%), UACR (41.1%), lipids (70.9%) and HbA1c (85.5%). ACEi/ARB were prescribed in 65.2% of the cohort and 54.4% were prescribed a statin. Blood pressure targets of <140/90 mmHg and <130/80 mmHg were achieved in 57.9% and 29.3% of patients, respectively. LDL target of <2 mmol/L was achieved in 38.8% of patients. Older age, comorbid diabetes and hypertension were associated with a greater likelihood of monitoring and medication prescription.
In this large, population-based study, we observed substantial variation in CKD risk monitoring and the management of cardiovascular risk in patients with CKD. We identified several priority areas for CKD management in primary care including need for improvement in albuminuria monitoring.
University of New South Wales Scientia Program and Boehringer Ingelheim Eli Lilly Alliance.
慢性肾脏病（CKD）监测和心血管风险管理对于减缓疾病进展和减少心血管事件至关重要。本研究旨在了解澳大利亚初级医疗中CKD的监测和管理实践。
我们对2011年1月1日至2020年6月30日期间参与医学洞察项目的全科医疗服务机构中符合CKD诊断标准的成年患者进行了一项基于人群的回顾性队列研究。在确诊CKD后的18个月内评估医疗质量。核心监测定义为对以下所有测量指标至少进行一次评估：血压、估算肾小球滤过率（eGFR）、尿白蛋白肌酐比值（UACR）、血脂谱以及糖尿病患者的糖化血红蛋白（HbA1c）。心血管风险管理包括药物处方（ACEI/ARB和他汀类药物）、血压目标达成情况以及低密度脂蛋白胆固醇（LDL）<2 mmol/L。使用针对社会人口学和临床特征进行调整的修正泊松回归模型来确定与监测完成情况和药物处方相关的患者因素。
共识别出140780例CKD患者，其中34.2%在确诊CKD后的18个月内接受了核心监测。核心监测结果各单项指标的测量情况有所不同：血压（88.7%）、eGFR（86.0%）、UACR（41.1%）、血脂（70.9%）和HbA1c（85.5%）。队列中65.2%的患者开具了ACEI/ARB，54.4%的患者开具了他汀类药物。血压目标<140/90 mmHg和<130/80 mmHg分别在57.9%和29.3%的患者中得以实现。38.8%的患者实现了LDL目标<2 mmol/L。年龄较大、合并糖尿病和高血压与监测及药物处方的可能性更大相关。
在这项基于人群的大型研究中，我们观察到CKD风险监测以及CKD患者心血管风险的管理存在显著差异。我们确定了初级医疗中CKD管理的几个优先领域，包括需要改进蛋白尿监测。
新南威尔士大学科学项目和勃林格殷格翰 - 礼来联盟。
Zotero 插件
