Chronic kidney disease prevalence and rate of diagnosis

BACKGROUND: Chronic kidney disease is a major public health problem. However, no study to date has estimated the prevalence of chronic kidney disease based on the clinical guidelines established by the National Kidney Foundation and few studies have explored the rate of diagnoses by primary care providers. SUBJECTS AND METHODS: Cross-sectional study of ambulatory patients in Rochester, NY. The purpose of this study was to estimate the prevalence of chronic kidney disease and the rate of primary caregiver diagnosis in ambulatory patients with chronic kidney disease. RESULTS: Among the 24,492 outpatients that had at least 2 glomerular filtration rate estimates >= 3 months apart, 6895 had an estimated glomerular filtration rate < 60 mL/min/ 1.73 m(2), indicating a 28.2% period prevalence of chronic kidney disease. The rate of clinical diagnosis among those with chronic kidney disease was 26.5% (95% confidence interval, 17.9 to 35.1), suggesting that 74% of patients with chronic kidney disease are undiagnosed. CONCLUSIONS: We demonstrate that the prevalence of chronic kidney disease is substantially higher in health-seeking individuals than in the general population. Moreover, we demonstrate that laboratory reporting of estimated glomerular filtration rate using the Modification of Diet in Renal Disease equation alone does not result in an optimal rate of clinical diagnosis. (C) 2007 Elsevier Inc. All rights reserved.