title: Prevalence of chronic kidney disease and its risk factors among family practice patients in Lithuania.
abstract: BACKGROUND
  Early detection of chronic kidney disease (CKD) by the first line is essential. In many countries, serum creatinine measurements are reimbursed in home practice. In Lithuania however, until recently they were not. Therefore, the aim of this study was to assess the prevalence of risk factors of CKD in primary care patients, to evaluate the awareness of family practitioners and, finally, to investigate renal function parameters in patients at risk.
  
  
  METHODS
  We reviewed the charts of adult patients (n = 4,082) from four home practices in Kaunas and identified patients at increased risk for CKD (severe arterial hypertension, diabetes, cardiovascular disease (CVD), other causes of kidney damage). We noted age and gender in all patients, and renal function measurements performed over the preceding 24 months in the patients at risk. In the second part, we assessed nephrological status (history, clinical characteristics, serum creatinine, dipstick urinalysis and microalbuminuria, estimated glomerular filtration rate (eGFR) by the abbreviated MDRD formula) for those at risk who were referred by their family practitioners.
  
  
  RESULTS
  In total, 458 (11.2%) patients had risk factors for CKD. Severe arterial hypertension was found in 62.6% of these patients, diabetes in 20.9%, CVD in 6.2% and 34.5% had a history of kidney damage. Kidney tests had been performed by family practioner in 59% of these patients. Only 30.3% of these patients were referred to the nephrologist and an additional 20.1% came after receiving an invitation letter. eGFR < 60 ml/min/1.73 m2 was found in 42.9% of these patients, 23.4% had microalbuminuria and 7.8% overt proteinuria. Optimal blood pressure control (< 130/85 mmHg) was achieved in a minority (10.4%). 79.7% had abnormal BMI, 39% used no ACEI/ARB, and 16% were smokers. Kidney dysfunction was associated with a higher prevalence of microalbuminuria and a lower use of ACEI/ ARB.
  
  
  CONCLUSIONS
  Risk factors for CKD were present in 11% of the patients in this primary care cohort. Kidney dysfunction was found in almost half of the patients at risk. However, awareness of this problem by family practitioners was low.
authors.affiliation: Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Inga Arūne
authors.initials: IA
authors.lastname: Bumblyte
authors.forename: Alanta
authors.initials: A
authors.lastname: Zilinskiene
authors.forename: Raymond
authors.initials: R
authors.lastname: Vanholder
authors.forename: Leonas
authors.initials: L
authors.lastname: Valius
authors.forename: Vytautas
authors.initials: V
authors.lastname: Kuzminskis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000453:epidemiology; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D008097:Lithuania / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000503:physiopathology* / Q000652:urine; D012307:Risk Factors; D016482:Urinalysis
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D003404:Creatinine