Keywords: Chronic kidney disease, primary care, early diagnosis, clinical management, diagnostic protocols

Background:

Chronic Kidney Disease (CKD) represents a major public health concern characterized by structural or functional renal abnormalities persisting for at least three months. CKD is classified based on estimated glomerular filtration rate (eGFR) stages (G1-G5) and albuminuria grades (A1-A3). In Italy, the prevalence of CKD is projected to increase from 3.9 million patients in 2021 to 4.4 million by 2026, with escalating mortality rates. Notably, CKD remains a "silent epidemic," frequently under-diagnosed in primary care settings. General Practitioners (GPs) represent the first point of contact for patients and hold a pivotal role in early identification, diagnostic screening, and appropriate management to slow disease progression.

Research questions:

Evaluate the adequacy of diagnostic approaches adopted by GP in early detection of CKD and to assess the quality of clinical management of CKD patients according to current national guidelines

Method:

A single-center, retrospective study was conducted at Casa di Salute Verona. Patient data were collected over a four-year period (January 2020--December 2024) from a single GP's ambulatory practice

Results:

The study population demonstrated a median age of 72 years (range 50-99) with 48% female representation. Hypertension and diabetes mellitus were present in 90.7% and 18.3% of patients, respectively. CKD prevalence (defined as eGFR <60 mL/min and/or abnormal albuminuria) was identified in 13.2% of the analyzed cohort, with higher prevalence in older age groups. Only 54.2% of patients with documented CKD underwent microalbuminuria screening, and 58% had ACR determination; proteinuria measurements were performed in only 1% of eligible cases

Conclusions:

Current diagnostic protocols recommended by national guidelines are insufficiently implemented in primary care practice. Diagnostic tools remain inadequately adapted to support GPs in early detection and prevention of CKD. Implementation of clinical decision support systems, automated alerts for at-risk populations, and enhanced coordination between GPs and specialists represents essential strategies to improve patient outcomes and reduce healthcare costs.

Points for discussion:

How to improve adherence to guidelines

how to manage high-risk populations, especially in patients over 80 years

European experience in managing this condition with specialists