High unawareness of kidney dysfunction in European older adults and the importance of early detection through comorbidities.

Abstract

Chronic kidney disease (CKD) continues to go undiagnosed at significant rates in Europe, with few exploring the underlying mechanisms which prompt detection. Considering the causal link of numerous health conditions and CKD, this study investigates how individual and combined comorbidities are associated with the likelihood of CKD detection. In a large population study (n = 22,386) of older adults (50+) among 11 European countries and Israel, we calculate the prevalence of undiagnosed CKD using serum-equivalent cystatin C values, derived from dried blood spots. Logistic regressions are estimated to predict factors related to CKD diagnosis among the population and among those with diagnosed vs. undiagnosed CKD. Unawareness of CKD among older adults is estimated at 11% in the population and ~85% among CKD cases, with country heterogeneity. Common conditions which should prompt screening, such as hypertension and diabetes, do not increase the likelihood of CKD diagnosis among those with reported and measured CKD. Instead, conditions which are demanding in terms of pain and continuous care, such as cancer and arthritis, are associated with an increased likelihood of CKD detection. However, even in the case of four or more comorbidities, the likelihood of CKD detection is only 27.3%. Women and older individuals are more likely to remain undiagnosed. In order to increase the chance of detection, comorbidities need to be better interpreted as early warning signals of CKD.