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Chronic kidney disease in primary care in Germany

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Abstract

Aims

The continuing growth of the population with end-stage renal disease (ESRD) in the past two decades has been recognized as a global health burden. In 2002, a definition of chronic kidney disease (CKD) was introduced and different categories of CKD have been reported in the general population. In this study, we examined the prevalence of CKD in primary health care in Germany.

Subjects and methods

From 2004 to 2007 the prevalence of CKD was estimated in the Diabetes Cardiovascular Risk-Evaluation Targets and Essential Data for Commitment of Treatment (DETECT) study using the Simplified Modification of Diet in Renal Disease (MDRD) and the CKD Epidemiology Collaboration (CKD-EPI) equations. A sample of 4,080 subjects were analysed with detailed laboratory and comorbidity assessment from 851 primary care centres across Germany.

Results

The prevalence of CKD (≤60 ml/min/1.73 m2) was 27.9 % estimated by CKD-EPI equation (MDRD eGFR 36.1 %) and the prevalence of CKD increased with age and during follow-up. The overall decline in eGFR per year was −1.83 ml/min/year (CKD-EPI). Women have shown a higher decline in eGFR than men. The prevalence of CKD was highest in coronary artery disease patients, followed by diabetes mellitus and arterial hypertension. Individuals with diabetes mellitus have shown the highest progress developing CKD.

Conclusion

In this representative sample of patients seeking medical advice in primary care, the prevalence of impaired kidney function was almost one third. Given the therapeutic implications, our results call for focused measures to increase the awareness of CKD in primary care.

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Acknowledgements

We extend our appreciation to the participants of the DETECT study. We thank the DETECT study team which was either temporarily or permanently involved in patient recruitment, sample and data handling. We also would like to thank and the laboratory staff at the Clinical Institute of Medical and Chemical Laboratory Diagnostics of the Medical University in Graz (Austria).

Author information

Authors and Affiliations

  1. Vth Department of Medicine, Nephrology, Endocrinology, Diabetology and Rheumatology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Germany

    Ingrid Gergei, Bernhard K. Krämer & Winfried März

  2. German Rheumatism Research Centre, a Leibniz Institute, Chariteplatz 1, Berlin, 10117, Germany

    Jens Klotsche

  3. Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin, Luisenstr. 57, 10117, Berlin, Germany

    Jens Klotsche

  4. Division of Nephrology, Department of Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany

    Rainer P. Woitas

  5. Institute of Clinical Psychology and Psychotherapy, Centre of Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany

    Lars Pieper & Hans-Ulrich Wittchen

  6. Division of Nephrology, Department of Medicine I, University of Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany

    Christoph Wanner

  7. Department of Nephrology, University of Erlangen-Nürnberg and KfH Kidney Center, Isoldenstrasse 15, 80804, München, Germany

    Johannes F. E. Mann

  8. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria

    Hubert Scharnagl & Winfried März

  9. Synlab Academy, Synlab Holding GmbH, P5, 7, 68161, Mannheim, Germany

    Winfried März

  10. Department of Medicine, Division of Nephrology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Frankfurt am Main, Germany

    Ulrich Mondorf

  11. UM Healthcare Frankfurt, Gartenstraße 134, 60596, Frankfurt, Germany

    Ulrich Mondorf

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  1. Ingrid Gergei
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  3. Rainer P. Woitas
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  4. Lars Pieper
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Corresponding author

Correspondence to Ingrid Gergei.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflicts of interest

Ingrid Gergei declares that he has no conflict of interest. Dr. Jens Klotsche declares that he has no conflict of interest. Professor Dr. Rainer P. Woitas declares that he has no conflict of interest. Professor Dr. Lars Pieper declares that he has no conflict of interest. Professor Dr. Hans-Ulrich Wittchen has received research grants from Novartis, Lundbeck, Pfizer and Servier and serves on committees of Lundbeck. Professor Bernhard Krämer has received speaker honoraria or travel grants from Astellas, Bayer, Chiesi and Pfizer and is a member of advisory committees for Chiesi and Bayer. Professor Dr. Christoph Wanner has received research grants from Genzyme/Sanofi and has received a speaker honorarium from Boehringer-Ingelheim. Professor Dr. Johannes F.E. Mann declares that he has no conflict of interest. Dr. Hubert Scharnagl declares that he has no conflict of interest. Professor Dr. Winfried März reports that he has been employed with from Synlab Holding Deutschland GmbH, during the conduct of the study; received grants and personal fees from Siemens Diagnostics, grants and personal fees from Aegerion Pharmaceuticals, grants and personal fees from AMGEN, grants and personal fees from AstraZeneca, grants and personal fees from Danone Research, grants and personal fees from Sanofi, personal fees from Hoffmann LA Roche, personal fees from MSD, grants and personal fees from Pfizer, personal fees from Alexion, grants and personal fees from BASF, grants from Abbott Diagnostics, all outside the submitted work. Professor Dr. Ulrich Mondorf declares that he has no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Funding Sources

The DETECT (Diabetes Cardiovascular Risk evaluation: Targets and Essential Data for Commitment of Treatment) - study was supported by an unrestricted educational grant of Pfizer GmbH, Karlsruhe, Germany. The sponsors of the study had no influence on the design, analysis or interpretation of data.

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ESM 1

(DOC 130 kb)

Fig. S1

Prevalence of eGFR level estimated with the Modification of Diet in Renal Disease (MDRD) formula for 2004 (a) and 2007 (b), respectively. All values are shown in absolute numbers (N) and relative frequencies (%) within eGFR (in ml/min/1.73 m2) and age (in decades) stratum. (DOC 50 kb)

Fig. S2

Prevalence of chronic kidney disease (defined as eGFR ≤ 60 ml/min/1.73 m2) in patient subgroups with combined comorbidities. DM diabetes mellitus; AH arterial hypertension; CHD coronary heart disease; HL hyperlipidaemia in DETECT 2004 (black bars) and 2007 (white bars). Glomerular filtration rate is estimated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. (DOC 32 kb)

Fig. S3

Prevalence of chronic kidney disease (defined as eGFR ≤ 60 ml/min/1.73 m2) in men and by different comorbidities: DM diabetes mellitus; AH arterial hypertension; CHD coronary heart disease; HL hyperlipidaemia in DETECT 2004 (black bars) and 2007 (white bars). Glomerular filtration rate is estimated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. (DOC 36 kb)

Fig. S4

Prevalence of chronic kidney disease (defined as eGFR ≤ 60 ml/min/1.73 m2) in women and by different comorbidities: diabetes mellitus; arterial hypertension; CHD coronary heart disease; HL hyperlipidaemia in DETECT 2004 (black bars) and 2007 (white bars). Glomerular filtration rate is estimated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. (DOC 32 kb)

Fig. S5

Prevalence of chronic kidney disease (defined as eGFR ≤ 60 ml/min/1.73 m2) in patient subgroups with different comorbidities in DETECT 2004 (black bars) and 2007 (white bars). DM diabetes mellitus; AH arterial hypertension; CHD coronary heart disease; HL hyperlipidaemia. Glomerular filtration rate is estimated by the Modification of Diet in Renal Disease (MDRD) equation. (DOC 32 kb)

Fig. S6

Prevalence of chronic kidney disease (defined as eGFR ≤ 60 ml/min/1.73 m2) in patient subgroups with combined comorbidities. DM diabetes mellitus; AH arterial hypertension; CHD coronary heart disease; HL hyperlipidaemia in DETECT 2004 (black bars) and 2007 (white bars). Glomerular filtration rate is estimated by the Modification of Diet in Renal Disease (MDRD) equation. (DOC 32 kb)

Fig. S7

Prevalence of chronic kidney disease (defined as eGFR ≤ 60 ml/min/1.73 m2) in men and by different comorbidities: DM diabetes mellitus; AH arterial hypertension; CHD coronary heart disease; HL hyperlipidaemia in DETECT 2004 (black bars) and 2007 (white bars). Glomerular filtration rate is estimated by the Modification of Diet in Renal Disease (MDRD) equation. (DOC 32 kb)

Fig. S8

Prevalence of chronic kidney disease (defined as eGFR ≤ 60 ml/min/1.73 m2) in women and by different comorbidities: DM diabetes mellitus; AH arterial hypertension; CHD coronary heart disease; HL hyperlipidaemia in DETECT 2004 (black bars) and 2007 (white bars). Glomerular filtration rate is estimated by the Modification of Diet in Renal Disease (MDRD) equation. (DOC 32 kb)

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Gergei, I., Klotsche, J., Woitas, R.P. et al. Chronic kidney disease in primary care in Germany. J Public Health 25, 223–230 (2017). https://doi.org/10.1007/s10389-016-0773-0

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