One in Three High-Risk Outpatients Has CKD — and Most Go Undertreated
A Central European tertiary care study finds CKD in 32.5% of at-risk outpatients, with a major gap in renoprotective therapy use.
Summary
A cross-sectional study screened nearly 2,000 internal medicine outpatients in Prague and found chronic kidney disease (CKD) in almost one in three. Hypertension, diabetes, heart failure, and age were the strongest risk factors. Critically, the drugs now proven to slow kidney decline — SGLT2 inhibitors, GLP-1 receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists — were dramatically underused in eligible patients. Modeling suggested that initiating full renoprotective therapy could extend dialysis-free survival by over 11 months per patient on average. One new CKD case was found for every five patients screened, underscoring that targeted screening in high-risk populations is both efficient and clinically impactful. The findings highlight a serious treatment gap with direct implications for healthspan.
Detailed Summary
Chronic kidney disease is one of the most underappreciated threats to healthy aging. It accelerates cardiovascular disease, muscle loss, and cognitive decline, and its progression to dialysis or transplant represents a catastrophic loss of functional capacity and lifespan. Yet CKD often develops silently, going undetected until advanced stages.
This cross-sectional study from the Institute of Clinical and Experimental Medicine in Prague screened 1,933 adults attending tertiary care outpatient clinics who were considered at risk for CKD. A broader cohort of 2,903 patients with available laboratory data was used for secondary analyses. CKD was defined using standard KDIGO criteria — combining estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR) measurements.
The headline result: 32.5% of screened patients met CKD criteria, a strikingly high prevalence. Importantly, one new case was identified for every 5.2 patients screened, demonstrating that targeted screening works. The strongest independent risk factors were non-renal organ transplantation (OR 4.38), age (OR 3.81 per 25-year increment), hypertension (OR 2.61), type 1 diabetes (OR 1.97), heart failure or atrial fibrillation (OR 1.59), atherosclerotic disease (OR 1.49), and type 2 diabetes (OR 1.46).
Despite the availability of effective renoprotective agents, uptake was alarmingly low among eligible patients: SGLT2 inhibitors were prescribed to only 42%, GLP-1 receptor agonists to 41.7%, and nonsteroidal mineralocorticoid receptor antagonists — a newer class with proven kidney-protective effects — to just 6.7%. A prognostic model estimated that initiating full renoprotective therapy could gain patients an average of 11.13 months of dialysis-free time.
For longevity-focused clinicians and health-conscious adults, the takeaway is clear: CKD is common, frequently missed, and undertreated even when detected. Routine uACR and eGFR monitoring in anyone with hypertension, diabetes, or cardiovascular disease — combined with aggressive use of SGLT2 inhibitors and GLP-1 agonists — represents one of the most impactful and underutilized strategies to protect both kidney function and long-term healthspan.
Key Findings
- CKD prevalence was 32.5% in at-risk tertiary care outpatients; one new case found per 5.2 patients screened.
- Hypertension (OR 2.61), age, and non-renal transplantation (OR 4.38) were the strongest CKD risk factors.
- SGLT2 inhibitors prescribed to only 42% of eligible CKD patients; nonsteroidal MRAs to just 6.7%.
- Full renoprotective therapy projected to add an average of 11.13 months of dialysis-free time per patient.
- Targeted screening using eGFR plus uACR efficiently uncovered previously unrecognized CKD at high yield.
Methodology
Cross-sectional observational study of 1,933 at-risk adult outpatients (expanded cohort: 2,903) at a Central European tertiary care center in Prague. CKD was defined per KDIGO criteria using eGFR and urine albumin-creatinine ratio. Bayesian credible intervals were reported and age-calibrated eGFR thresholds were also applied; kidney transplant recipients were excluded.
Study Limitations
Cross-sectional design precludes causal inference and does not capture longitudinal kidney function trajectories. The study was conducted at a single tertiary care center in Central Europe, limiting generalizability to primary care or other geographic populations. The dialysis-free time projection is model-based and not derived from a randomized intervention. Summary is based on the abstract only, as the full text was not available.
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