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Abstract：
OBJECTIVE: Identify the windows of opportunity for the diagnosis of chronic kidney disease (CKD) and the prevention of its adverse outcomes and quantify the potential population gains of such prevention.
METHODS: Observational, population-wide study of residents in the Stockholm and Skåne regions of Sweden between 1 January 2015 and 31 December 2020.
METHODS: All patients who did not yet have a diagnosis of CKD in healthcare but had CKD according to laboratory measurements of CKD biomarkers available in electronic health records.
METHODS: We assessed the proportions of the patient population that received a subsequent diagnosis of CKD in healthcare, that used guideline-directed pharmacological therapy (statins, renin-angiotensin aldosterone system inhibitors (RAASi) and/or sodium-glucose cotransporter-2 inhibitors (SGLT2i)) and that experienced adverse outcomes (all-cause mortality, cardiovascular mortality or major adverse cardiovascular events (MACE)). The potential to prevent adverse outcomes in CKD was assessed using simulations of guideline-directed pharmacological therapy in untreated subsets of the study population.
RESULTS: We identified 99 382 patients with undiagnosed CKD during the study period. Only 33% of those received a subsequent diagnosis of CKD in healthcare after 5 years. The proportion that used statins or RAASi was of similar size to the proportion that didn\'t, regardless of how advanced their CKD was. The use of SGLT2i was negligible. In simulations of optimal treatment, 22% of the 21 870 deaths, 27% of the 14 310 cardiovascular deaths and 39% of the 22 224 MACE could have been avoided if every patient who did not use an indicated medication for their laboratory-confirmed CKD was treated with guideline-directed pharmacological therapy for CKD.
CONCLUSIONS: While we noted underdiagnosis and undertreatment of CKD in this large contemporary population, we also identified a substantial realisable potential to improve CKD outcomes and reduce its burden by treating patients early with guideline-directed pharmacological therapy.
METHODS: Observational, population-wide study of residents in the Stockholm and Skåne regions of Sweden between 1 January 2015 and 31 December 2020.
METHODS: All patients who did not yet have a diagnosis of CKD in healthcare but had CKD according to laboratory measurements of CKD biomarkers available in electronic health records.
METHODS: We assessed the proportions of the patient population that received a subsequent diagnosis of CKD in healthcare, that used guideline-directed pharmacological therapy (statins, renin-angiotensin aldosterone system inhibitors (RAASi) and/or sodium-glucose cotransporter-2 inhibitors (SGLT2i)) and that experienced adverse outcomes (all-cause mortality, cardiovascular mortality or major adverse cardiovascular events (MACE)). The potential to prevent adverse outcomes in CKD was assessed using simulations of guideline-directed pharmacological therapy in untreated subsets of the study population.
RESULTS: We identified 99 382 patients with undiagnosed CKD during the study period. Only 33% of those received a subsequent diagnosis of CKD in healthcare after 5 years. The proportion that used statins or RAASi was of similar size to the proportion that didn\'t, regardless of how advanced their CKD was. The use of SGLT2i was negligible. In simulations of optimal treatment, 22% of the 21 870 deaths, 27% of the 14 310 cardiovascular deaths and 39% of the 22 224 MACE could have been avoided if every patient who did not use an indicated medication for their laboratory-confirmed CKD was treated with guideline-directed pharmacological therapy for CKD.
CONCLUSIONS: While we noted underdiagnosis and undertreatment of CKD in this large contemporary population, we also identified a substantial realisable potential to improve CKD outcomes and reduce its burden by treating patients early with guideline-directed pharmacological therapy.
摘要：
目的：确定慢性肾脏病（CKD）诊断和预防其不良后果的机会窗口，并量化此类预防的潜在人群收益。
方法：观察性，2015年1月1日至2020年12月31日期间对瑞典斯德哥尔摩和斯科恩地区居民进行的全人群研究。
方法：根据电子健康记录中的CKD生物标志物的实验室测量，所有在医疗保健中尚未诊断为CKD但患有CKD的患者。
方法：我们评估了在医疗保健中接受CKD后续诊断的患者人群的比例，使用指南指导的药物治疗(他汀类药物，肾素-血管紧张素-醛固酮系统抑制剂（RAASi）和/或钠-葡萄糖协同转运蛋白-2抑制剂（SGLT2i））和经历不良结局（全因死亡率，心血管死亡或主要不良心血管事件（MACE）。在研究人群的未治疗亚组中，使用指南指导的药物治疗模拟评估了预防CKD不良结局的可能性。
结果：我们在研究期间确认了99382例CKD患者未确诊。5年后，只有33％的人在医疗保健中接受了CKD的后续诊断。使用他汀类药物或RAASI的比例与未使用他汀类药物或RAASI的比例相似，不管他们的CKD有多先进。SGLT2i的使用可以忽略不计。在最佳治疗的模拟中，21870例死亡中的22%，14310例心血管死亡中的27%和22224例MACE中的39%是可以避免的，如果每个没有使用实验室确认的CKD指定药物的患者都接受指导的CKD药物治疗。
结论：虽然我们注意到在这个庞大的当代人群中CKD的诊断和治疗不足，我们还发现,通过早期接受指南指导的药物治疗,可以改善CKD结局并减轻其负担.
方法：观察性，2015年1月1日至2020年12月31日期间对瑞典斯德哥尔摩和斯科恩地区居民进行的全人群研究。
方法：根据电子健康记录中的CKD生物标志物的实验室测量，所有在医疗保健中尚未诊断为CKD但患有CKD的患者。
方法：我们评估了在医疗保健中接受CKD后续诊断的患者人群的比例，使用指南指导的药物治疗(他汀类药物，肾素-血管紧张素-醛固酮系统抑制剂（RAASi）和/或钠-葡萄糖协同转运蛋白-2抑制剂（SGLT2i））和经历不良结局（全因死亡率，心血管死亡或主要不良心血管事件（MACE）。在研究人群的未治疗亚组中，使用指南指导的药物治疗模拟评估了预防CKD不良结局的可能性。
结果：我们在研究期间确认了99382例CKD患者未确诊。5年后，只有33％的人在医疗保健中接受了CKD的后续诊断。使用他汀类药物或RAASI的比例与未使用他汀类药物或RAASI的比例相似，不管他们的CKD有多先进。SGLT2i的使用可以忽略不计。在最佳治疗的模拟中，21870例死亡中的22%，14310例心血管死亡中的27%和22224例MACE中的39%是可以避免的，如果每个没有使用实验室确认的CKD指定药物的患者都接受指导的CKD药物治疗。
结论：虽然我们注意到在这个庞大的当代人群中CKD的诊断和治疗不足，我们还发现,通过早期接受指南指导的药物治疗,可以改善CKD结局并减轻其负担.
