Adherence to the KDIGO Chronic Kidney Disease Guideline in Nephrology Practice across Countries

ABSTRACT Introduction The uptake of the KDIGO 2012 CKD Guideline is not fully described in real-world nephrology practice across the world. Methods We used baseline data from the CKD Outcomes and Practice Patterns Study (2013-17), a four-country cohort of patients with estimated glomerular filtration rate (eGFR) Results Mean age ranged from 65 in Brazil to 72 in Germany. Albuminuria (mostly proteinuria) was measured routinely in 36% to 43% of patients in Brazil, Germany, and the US. Blood pressure (BP) control (≤140/90 mmHg) ranged from 49% in France to 76% in Brazil; fewer than 40% of patients had BP ≤130/80 everywhere but Brazil (52%). Over 40% of nephrologists in Brazil reported systolic BP target ≤130 for nondiabetic patients without proteinuria, but only 19% to 24% elsewhere. Prescription of renin-angiotensin aldosterone system (RAAS) inhibitors ranged from 52% in the US to 81% in Germany. Dietary advice was more frequent for salt than protein intake; dietitian visits were uncommon. In nondiabetic patients, achievement of all three targets including BP ≤130/80, RAAS inhibition, and dietary advice, ranged from 10% in the US to 32% in Brazil; in treated diabetic patients, this ranged from 6 to 11% after including HbA1c target. Conclusion Adherence to recommendations to slow CKD progression is low in typical practice settings, and substantial variation among countries for some indicates opportunities for improvement.