Management and Treatment of Chronic Kidney Disease in the Danish Lolland-Falster Health Study: Focus on Renoprotection and Cardiovascular Disease Prevention

BACKGROUND: In the Danish population-based Lolland-Falster Health Study (LOFUS), we recently identified a chronic kidney disease (CKD) prevalence of 18%. Importantly, overall disease recognition was only 7.1%, and awareness was as low as 4.4%. This reveals a significant gap in identifying CKD, consequently delaying initiation of guideline-directed renoprotective treatments, cardiovascular disease prevention, and referrals to specialized nephrology care.

METHODS: Cross-sectional study including adult participants with CKD identified in LOFUS. Data were obtained from biochemical analyses, clinical examinations, and questionnaires. Redeemed prescriptions and nephrology referrals were assessed using national medical registers. Blood pressure control, treatment with renin-angiotensin-system inhibitors and statins, as well as lifestyle factors were examined, and their association with CKD stage analyzed.

RESULTS: Among 2881 individuals with CKD, 57.6% were women, median age was 67.8 years, 71.3% were in CKD stages 1-2 and 21% had cardiovascular disease. Less than half of individuals had blood pressure control (47.5%). Treatment with renin-angiotensin-system inhibitors and statins, when indicated, were 72.8% and 32.2%, respectively, and more frequent in individuals with diabetes. In multivariable analyses, the odds ratios for blood pressure control (1.68; 95% CI,1.12-2.52), treatment with renin-angiotensin-system inhibitors (7.91; 95% CI,2.14-29.18), and statins (1.77; 95% CI,1.06-2.96) were significantly higher in stages 3b-5 compared to stage 1. Less than one-third had a BMI <25 kg/m 2 and >80% self-reported non-smoking. Of those meeting nephrology referral criteria ( n = 99), one-third had been referred.

CONCLUSION: Our findings highlight gaps between guideline-recommended CKD management and practice, particularly in early stages and in non-diabetic individuals, emphasizing the need for early detection and improved guideline adherence.