MO509: Reveal-CKD: Prevalence of Undiagnosed Stage 3 Chronic Kidney Disease Italy
Bibliographic record
Abstract
Abstract BACKGROUND AND AIMS Chronic kidney disease (CKD) is a serious progressive disease with a substantial impact on global health that affects ∼10% of the world's population. However, CKD remains largely under-recognized. Effective actions to slow disease progression and improve outcomes depend on timely detection and diagnosis before a further decline in estimated glomerular filtration rate (eGFR). The aim of the REVEAL-CKD study is to assess the prevalence of, and factors associated with, undiagnosed early (stage 3) CKD. METHOD REVEAL-CKD is a multi-national, multi-regional observational study using secondary data from electronic medical records and claims databases. In this analysis, we extracted data regarding patient demographics, laboratory tests, diagnoses and treatments from an Italian electronic medical record database, the Italian Longitudinal Patients Database (IQVIA, Italy). The Italian Longitudinal Patients Database consists of anonymised patient records collected from routine visits to general practitioners and represents ∼900 general practitioners and 1.2 million patients across Italy. The study cohort included patients aged ≥18 years between 2015–21 with two consecutive estimated glomerular filtration rate (eGFR) results ≥30 and <60 mL/min/1.73 m2 recorded >90 and ≤730 days apart. The date of the second qualifying eGFR was defined as the index date. Patients with no presence of a CKD diagnostic code recorded any time before their first qualifying eGFR and up to 6 months after their second qualifying eGFR were considered to be undiagnosed. The prevalence of undiagnosed CKD was calculated as the ratio of undiagnosed patients to all patients who met the study inclusion criteria. RESULTS The study cohort included 65 676 patients who met the eGFR criteria for stage 3 CKD. The mean age at index date was 79 years (standard deviation: 9 years) and 58% were female. The overall prevalence of undiagnosed CKD was 77.0% [95% confidence interval (CI): 76.6–77.3]. The prevalence of undiagnosed CKD was greater in patients with stage 3a CKD (83.0%) compared with those with stage 3b CKD (64.8%). Female patients and those aged > 65 years showed a higher prevalence of undiagnosed CKD, and the prevalence of undiagnosed CKD ranged from 66.6% to 75.7% in patients with pre-existing comorbidities (Table 1). In patients who were undiagnosed at the index date (n = 52 533), 15.5% (n = 8152) were diagnosed with CKD after the index date, with a median time to diagnosis of 404 days (IQR: 389–418 days); 84.5% (n = 44 381) remained undiagnosed. CONCLUSION This study indicates that a high proportion of patients with stage 3 CKD are undiagnosed by their general practitioners, with inequity noted for females and older patients. Underdiagnosis of CKD persisted in those with known risk factors for CKD such as diabetes, heart failure and hypertension. With the availability of targeted evidence-based therapies to decrease the risk of disease progression and improve patient outcomes, there is a clear need to proactively detect, diagnose and intervene in patients with early-stage CKD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".