High Prevalence of Unrecorded Stage 3 Chronic Kidney Disease in Australia, Brazil, Canada, England, and Spain: The Multinational, Observational REVEAL‐CKD Study
Bibliographic record
Abstract
Background: Chronic kidney disease (CKD) is a global public health concern, affecting approximately 850 million people worldwide. Guidelines recommend early identification and management of CKD to mitigate disease progression and delay the onset of complications. Recording a CKD diagnosis in medical records is associated with improved kidney function and blood pressure monitoring, better use of disease‐modifying therapy, and reduced risk of CKD progression. REVEAL‐CKD is a multinational, observational study that aims to estimate the prevalence of stage 3 CKD which is unrecorded in administrative databases. Methods: Data were extracted from country‐specific databases of patient medical records in Australia, Brazil, Canada, England, and Spain. Included patients (aged ≥ 18 years) had two consecutive estimated glomerular filtration rate (eGFR) measurements between 30 and < 60 mL/min/1.73 m2 taken 91–730 days apart. Patients were considered to have unrecorded CKD if they had no CKD diagnosis code (any stage) at any time before and up to 6 months after study index (date of second qualifying eGFR). Results: Across countries, median age was 72–78 years, median eGFR was 46.5–53.5 mL/min/1.73 m2, and availability of urinary albumin—creatinine ratio testing ranged from 4.9% (Brazil) to 53.5% (Canada). The prevalence of unrecorded stage 3 CKD was 90.0% (1002/1113 patients) in Australia, 97.0% (10,925/11,262) in Brazil, 92.0% (42,226/45,914) in Canada, 56.9% (84,237/148,153 in England, and 84.8% (27,035/31,866) in Spain. Conclusions: More than half of the patients with laboratory evidence of stage 3 CKD lacked a CKD diagnosis code in all countries examined. Substantial intercountry variations in rates of CKD recording and testing were observed. International sharing of best practice guidance, systematic changes to improve data quality, and increased awareness of the importance of timely coding among healthcare professionals will help to improve accurate recording of stage 3 CKD. Trial Registration: ClinicalTrials.gov identifier: NCT04847531 .
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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 | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".