Prevalence of chronic kidney disease stages 3-5 among acute medical admissions: another opportunity for screening.
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.


OBJECTIVE
To define the prevalence of CKD Stages 3-5 and related anaemia among acute medical admissions.


METHODS
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 micromol/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 micromol/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.
Annear
N M P
NM
Department of Renal Medicine and Transplantation, St Georges Hospital, London SW17 0QT, UK.
Banerjee
D
D
Joseph
J
J
Harries
T H
TH
Rahman
S
S
Eastwood
J B
JB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology*; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies
D003404:Creatinine