NAU ‐ New NAU - Areas of Unifying Interest for CKD: A Multidisciplinary Expert Opinion Using the Jandhyala Method

Authors

  • Jorge Malheiro Nephrology Department, Centro Hospitalar e Universitário de Santo António, ULS de Santo António, Porto, Portugal; Instituto de Ciências Biomédicas de Abel Salazar Universidade do Porto (ICBAS/UP), Porto, Portugal Author https://orcid.org/0000-0002-9625-5889
  • Francisco Araújo Internal Medicine Department, Hospital Lusíadas, Lisbon, Portugal Author https://orcid.org/0000-0002-9625-5889
  • Andreia Nunes Internal Medicine Department, Hospital Garcia de Orta EPE, Almada, Portugal Author https://orcid.org/0000-0001-6743-9868
  • Clara Almeida Nephrology Department, Unidade Local de Saúde Gaia Espinho, Vila Nova de Gaia, Portugal Author
  • Inês Aires Nephrology and Transplant Unit, Hospital Curry Cabral, Unidade Local de Saúde São José, Lisboa, Portugal Author https://orcid.org/0000-0001-6451-0331
  • João Pedro Nobre USF Rodrigues Miguéis, Unidade Local de Saúde de Santa Maria, ACeS Lisboa Norte, Portugal Author https://orcid.org/0009-0002-8491-7563
  • João Sérgio Neves Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar Universitário de São João, Unidade Local de Saúde de São João, Porto, Portugal Author https://orcid.org/0000-0002-8173-8255
  • Jordana Dias Guarda Customized Healthcare Unit, ACES Guarda, Unidade Local de Saúde da Guarda, Guarda, Portugal Author
  • Miguel Bigotte Vieira Nephrology and Transplant Unit, Hospital Curry Cabral, Unidade Local de Saúde São José, Lisboa, Portugal; NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal Author https://orcid.org/0000-0003-0528-2716
  • Miguel Melo Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar e Universitário de Coimbra, ULS Coimbra EPE, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal Author https://orcid.org/0000-0002-8365-1380
  • Nuno Capela USF Serpa Pinto, ACeS Porto Ocidental, Unidade Local de Saúde de Santo António, Porto, Portugal Author https://orcid.org/0000-0001-9631-321X
  • Susana Heitor Internal Medicine Department, Integrated Diabetes Unit, Hospital Prof Doutor Fernando Fonseca, Unidade Local Saúde de Amadora/Sintra, Amadora, Portugal Author https://orcid.org/0000-0001-6313-6421
  • João Couceiro AstraZeneca Portugal Author https://orcid.org/0000-0003-3640-1466
  • Hugo Martinho AstraZeneca Portugal Author
  • Leonor Luz-Duarte USF Caminho Novo, Unidade Local de Saúde Gaia Espinho, VNGaia, Portugal; MTG Research and Development Lab, Porto, Portugal Author https://orcid.org/0000-0001-5116-5014
  • Tiago Taveira-Gomes MTG Research and Development Lab, Porto, Portugal; Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto (MEDCIDS‐ ‐FMUP), Porto, Portugal; Faculty of Health Sciences, Fernando Pessoa University (FCS‐UFP), Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Porto, Portugal Author https://orcid.org/0000-0002-0998-6000

DOI:

https://doi.org/10.71749/pkj.38

Keywords:

Awareness, Consensus, Renal Insufficiency, Chronic

Abstract

Introduction: The global prevalence of chronic kidney disease (CKD) is rising exponentially. While patient awareness of CKD remains low, we studied the physicians’ awareness and how globally it can be improved. We aimed to evaluate the awareness and consensus of physicians on the screening, diagnosis and clinical management of CKD, thus identifying which areas should be the subject of educational or research programs.     Methods: Participants experienced in scientific research and interested in CKD were divided into two groups: primary and secondary care physicians. They underwent the Awareness Round with four open questions, followed by a Consensus Round to rate their level of agreement using a five‐point Likert scale‐ Jandhyala method.     Results: Results showed varying levels of awareness and consensus among primary and secondary care physicians. Both groups identified diabetes and hypertension as major risk factors for CKD development and progression, with high consensus indexes (CI). However, glomerulopathies, polycystic kidney disease, and acute kidney injury had low awareness indexes (AI) but high CI, especially in secondary care. Key barriers to CKD diagnosis in primary care included physician inertia (AI 100%) and lack of articulation between specialties (AI 77%). In secondary care, therapeutic inertia (AI 100%) and socioeconomic factors (AI 84%) were significant limitations. Additionally, there was a notable disparity in the management of CKD between primary and secondary care. Primary care showed lower AI for promoting a healthy lifestyle (49%) and avoiding nephrotoxic drugs (25%) compared to secondary care (100% and 79%, respectively).     Conclusion: There is a need for educational programs for physicians exploring topics such as polycystic kidney disease, glomerulopathies and acute kidney disease; as well as the implementation of initiatives focused on CKD referral and management.

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References

GBD 2017 Disease and Injury Incidence and Prevalence Collabora‐ tors. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990‐2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392: 1789–58. doi: 10.1016/S0140‐6736(18)32279‐7.

GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990‐2017: a system‐ atic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395:709‐33. doi: 10.1016/S0140‐6736(20)30045‐3.

Jager KJ, Kovesdy C, Langham R, et al. A single number for advocacy and communication‐worldwide more than 850 million individuals have kidney diseases. Kidney Int. 2019;96:1048‐50. doi: 10.1016/j. kint.2019.07.012.

Bello AK, Johnson DW, Feehally J, Harris D, Jindal K, Lunney M, et al. Global Kidney Health Atlas (GKHA): design and methods. Kidney Int Suppl. 2017;7:145‐53. doi: 10.1016/j.kisu.2017.08.001.

Santos‐Araújo C, Mendonça L, Carvalho DS, Bernardo F, Pardal M, Couceiro J, et al. Twenty years of real‐world data to estimate chronic kidney disease prevalence and staging in an unselected population. Clin Kidney J. 2022;16:111‐24. doi: 10.1093/ckj/sfac206.

Ng JK, Li PK. Chronic kidney disease epidemic: How do we deal with it? Nephrology. 2018;23 Suppl 4:116‐20. doi: 10.1111/nep.13464.

Drey N, Roderick P, Mullee M, Rogerson M. A population‐based study of the incidence and outcomes of diagnosed chronic kid‐ ney disease. Am J Kidney Dis. 2003;42:677‐84. doi: 10.1016/ s0272‐6386(03)00916‐8.

Raymond NT, Zehnder D, Smith SC, Stinson JA, Lehnert H, Higgins RM. Elevated relative mortality risk with mild‐to‐moderate chronic kidney disease decreases with age. Nephrol Dial Transplant. 2007;22:3214‐ ‐20. doi: 10.1093/ndt/gfm396.

Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, et al. Global Prevalence of Chronic Kidney Disease‐ A Systematic Review and Meta‐Analysis. PLoS One. 2016;11:e0158765. doi: 10.1371/jour‐ nal.pone.0158765.

World Health Organization. The top 10 causes of death [accessed 26 October 2022] Available at: https://www.who.int/news‐room/ fact‐sheets/detail/the‐top‐10‐causes‐of‐death

Couser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major noncom‐ municable diseases. Kidney Int. 2011;80:1258‐70. doi: 10.1038/ ki.2011.368.

Coresh J, Hu JR, Bello AK, Feldman HI, Fogo AB, Ganji MR, et al. Ac‐ tion plan for determining and monitoring the prevalence of chronic kidney disease. Kidney Int Suppl. 2017;7:63‐70. doi: 10.1016/j. kisu.2017.07.002.

Vanholder R, Annemans L, Brown E, Gansevoort R, Gout‐Zwart JJ, Lameire N, et al. Reducing the costs of chronic kidney disease while delivering quality health care: a call to action. Nat Rev Nephrol. 2017;13:393‐409. doi: 10.1038/nrneph.2017.63.

Vinhas J, Aires I, Batista C, Branco P, Brandão J, Nogueira R, et al. RENA Study: Cross‐Sectional Study to Evaluate CKD Prevalence in Portugal. Nephron. 2020;144:479‐87. doi: 10.1159/000508678.

Foreman KJ, Marquez N, Dolgert A, Fukutaki K, Fullman N, McGaughey M, et al. Forecasting life expectancy, years of life lost, and all‐cause and cause‐specific mortality for 250 causes of death: reference and alternative scenarios for 2016‐40 for 195 countries and territories. Lancet. 2018;392:2052‐90. doi: 10.1016/S0140‐6736(18)31694‐5.

GBD 2017 Causes of Death Collaborators. Global, regional, and national age‐sex‐specific mortality for 282 causes of death in 195 countries and territories, 1980‐2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1736–88. doi: 10.1016/S0140‐6736(18)32203‐7.

Dunkler D, Kohl M, Heinze G, Teo KK, Rosengren A, Pogue J, et al. Modifiable lifestyle and social factors affect chronic kidney disease in high‐risk individuals with type 2 diabetes mellitus. Kidney Int. 2015;87:784‐91. doi: 10.1038/ki.2014.370.

Fraser SD, Roderick PJ, May CR, McIntyre N, McIntyre C, Fluck RJ, et al. The burden of comorbidity in people with chronic kidney disease stage 3: a cohort study. BMC Nephrol. 2015;16:193. doi: 10.1186/ s12882‐015‐0189‐z. Erratum in: BMC Nephrol. 2020;21:543. doi: 10.1186/s12882‐020‐02205‐w.

Mok Y, Ballew SH, Matsushita K. Prognostic Value of Chronic Kid‐ ney Disease Measures in Patients With Cardiac Disease. Circ J. 2017;81:1075–84.

Valmadrid CT, Klein R, Moss SE, Klein BE. The risk of cardiovascular disease mortality associated with microalbuminuria and gross pro‐ teinuria in persons with older‐onset diabetes mellitus. Arch Intern Med. 2000;160:1093‐100. doi: 10.1001/archinte.160.8.1093.

Yacoub R, Habib H, Lahdo A, Al Ali R, Varjabedian L, Atalla G, et al. Association between smoking and chronic kidney disease: a case control study. BMC Public Health. 2010;10:731. doi: 10.1186/1471‐2458‐10‐731.

Lu JL, Molnar MZ, Naseer A, Mikkelsen MK, Kalantar‐Zadeh K, Koves‐ dy CP. Association of age and BMI with kidney function and mortal‐ ity: a cohort study. Lancet Diabetes Endocrinol. 2015;3:704‐14. doi: 10.1016/S2213‐8587(15)00128‐X.

Soderland P, Lovekar S, Weiner DE, Brooks DR, Kaufman JS. Chronic kidney disease associated with environmental toxins and expo‐ sures. Adv Chronic Kidney Dis. 2010;17:254‐64. doi: 10.1053/j. ackd.2010.03.011.

Jha V, Garcia‐Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013;382:260‐72. doi: 10.1016/S0140‐6736(13)60687‐X. Erratum in: Lancet. 2013;382:208.

Ekrikpo UE, Kengne AP, Bello AK, Effa EE, Noubiap JJ, Salako BL, et al. Chronic kidney disease in the global adult HIV‐infected population: A systematic review and meta‐analysis. PLoS One. 2018;13:e0195443. doi: 10.1371/journal.pone.0195443.

Luyckx VA, Cherney DZ, Bello AK. Preventing CKD in Devel‐ oped Countries. Kidney Int Rep. 2020;5:263–77. doi: 10.1016/j. ekir.2019.12.003.

Bello AK, Ronksley PE, Tangri N, Kurzawa J, Osman MA, Singer A, et al. Quality of Chronic Kidney Disease Management in Canadian Primary Care. JAMA Netw Open. 2019;2:e1910704. doi: 10.1001/ jamanetworkopen.2019.10704.

Chow CK, Nguyen TN, Marschner S, Diaz R, Rahman O, Avezum A, et al. Availability and affordability of medicines and cardiovascular outcomes in 21 high‐income, middle‐income and low‐income countries. BMJ Glob Health. 2020;5:e002640. doi: 10.1136/ bmjgh‐2020‐002640.

Khatib R, McKee M, Shannon H, Chow C, Rangarajan S, Teo K, et al. Availability and affordability of cardiovascular disease medicines and their effect on use in high‐income, middle‐income, and low‐income countries: an analysis of the PURE study data. Lancet. 2016;387:61‐ ‐9. doi: 10.1016/S0140‐6736(15)00469‐9.

Luyckx VA, Tonelli M, Stanifer JW. The global burden of kidney dis‐ ease and the sustainable development goals. Bull World Health Organ. 2018;96:414–22D.

Ene‐Iordache B, Perico N, Bikbov B, Carminati S, Remuzzi A, Perna A, et al. Chronic kidney disease and cardiovascular risk in six regions of the world (ISN‐KDDC): a cross‐sectional study. Lancet Glob Health. 2016;4:e307‐19. doi: 10.1016/S2214‐109X(16)00071‐1.

Whaley‐Connell A, Shlipak MG, Inker LA, Kurella Tamura M, Bomback AS, Saab G, et al. Awareness of kidney disease and relationship to end‐stage renal disease and mortality. Am J Med. 2012;125:661‐9. doi: 10.1016/j.amjmed.2011.11.026.

Vanholder R, Annemans L, Bello AK, Bikbov B, Gallego D, Gansevoort RT, et al. Fighting the unbearable lightness of neglecting kidney health: the decade of the kidney. Clin Kidney J. 2021;14:1719‐30. doi: 10.1093/ckj/sfab070.

Bello AK, Levin A, Manns BJ, Feehally J, Drueke T, Faruque L, et al. Effective CKD care in European countries: challenges and opportuni‐ ties for health policy. Am J Kidney Dis. 2015;65:15‐25. doi: 10.1053/j. ajkd.2014.07.033.

Eckardt KU, Coresh J, Devuyst O, Johnson RJ, Köttgen A, Levey AS, et al. Evolving importance of kidney disease: from subspecialty to global health burden. Lancet. 2013;382:158‐69. doi: 10.1016/ S0140‐6736(13)60439‐0.

GBD 2015 Disease and Injury Incidence and Prevalence Collabora‐ tors. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990‐2015: a sys‐ tematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1545–602. doi: 10.1016/S0140‐6736(16)31678‐6.

Jandhyala R. A novel method for observing proportional group awareness and consensus of items arising from list‐generating questioning. Curr Med Res Opin. 2020;36:883–93. doi: 10.1080/03007995.2020.1734920.

Jandhyala R. Delphi, non‐RAND modified Delphi, RAND/UCLA appropriateness method and a novel group awareness and con‐ sensus methodology for consensus measurement: a systematic literature review. Curr Med Res Opin. 2020;36:1873–87. doi: 10.1080/03007995.2020.1816946.

Jandhyala R. Development and Validation of the Medical Affairs Phar‐ maceutical Physician Value (MAPPval) Instrument. Pharmaceut Med. 2022; 36: 47–57. doi: 10.1007/s40290‐021‐00413‐9.

Jandhyala R. Design, validation and implementation of the post‐acute (long) COVID‐19 quality of life (PAC‐19QoL) instrument. Health Qual Life Outcomes. 2021;19:229. doi: 10.1186/s12955‐021‐01862‐1.

Perrone RD, Ruthazer R, Terrin NC. Survival after end‐stage renal disease in autosomal dominant polycystic kidney disease: contri‐ bution of extrarenal complications to mortality. Am J Kidney Dis. 2001;38:777–84.

Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta‐analysis. Kidney Int. 2012;81:442–8.

Cravedi P, Remuzzi G. Pathophysiology of proteinuria and its value as an outcome measure in chronic kidney disease. Br J Clin Pharmacol. 2013;76:516–23.

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Published

20-08-2024

Data Availability Statement

LLD: material preparation, data collection, statistical analysis and writing the original draft. TTG: Study design and supervision, statistical analysis and critical reviewing of the content of the article. JC, HM: Study design and supervision and critical reviewing of the content of the article. JM, FA, AN, CA, IA, JPN, JSN, JD, MBV, MM, NC, SH: critical reviewing of the content of the article.

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Copyright (c) 2024 Jorge Malheiro, Francisco Araújo, Andreia Nunes, Clara Almeida, Inês Aires, João Pedro Nobre, João Sérgio Neves, Jordana Dias, Miguel Bigotte Vieira, Miguel Melo, Nuno Capela, Susana Heitor, João Couceiro, Hugo Martinho, Leonor Luz-Duarte, Tiago Taveira-Gomes (Author)

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NAU ‐ New NAU - Areas of Unifying Interest for CKD: A Multidisciplinary Expert Opinion Using the Jandhyala Method. (2024). Portuguese Kidney Journal. https://doi.org/10.71749/pkj.38

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