{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T21:38:36Z","timestamp":1793655516752,"version":"4.5.1"},"reference-count":40,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T00:00:00Z","timestamp":1746144000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Boehringer Ingelheim"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The underdiagnosis of chronic kidney disease (CKD) is a critical issue worldwide. This present study aimed to explore the CKD subpopulation regarding underdiagnosed CKD in individuals with a pathological estimated glomerular filtration rate (eGFR) and\/or urine albumin\u2013creatinine ratio (UACR) values in Germany. Materials and Methods: This analysis used data from the IQVIATM Disease Analyzer database and included adult outpatients with at least two pathological consecutive eGFR and\/or UACR values, documented at least 60 days apart between October 2018 and September 2023 in 758 general practices. According to the 2024 KDIGO clinical practical guidelines, CKD was defined based on both eGFR and UACR values. UACR values were used when no pathological eGFR values were documented. The main outcome of the study was the proportion of patients with a documented CKD in the total population as well as in defined subgroups. Results: A total of 113,996 CKD patients (mean age: 76.5 (SD: 10.1) years; 60.2% female; 71.5% with mildly to moderately, 21.1% with moderately to severely, and 4.6% with a severely decreased eGFR value; and 1.0% with end-stage kidney disease) were available for analyses. CKD diagnosis was documented in 46.9% of CKD patients and was more frequent in male than in female patients (53.3% versus 42.7%). The highest proportion was observed in patients with heart failure (57.0%), followed by patients with type 2 diabetes (52.7%). In patients without diabetes and heart failure, CKD was documented in 38.2%. The proportion of CKD diagnoses increased with decreasing eGFR values, from 22.0% in patients with nonpathological eGFR but moderately or severely increased UACR to 87.7% in patients with end-stage kidney disease. Conclusions: The study provides valuable insights into the subpopulation of underdiagnosed CKD patients among a large patient population. These results underscore the need for improved screening, timely diagnosis documentation, and treatment strategies for CKD, particularly among high-risk populations. Moreover, it raises the need to increase awareness of micro- and macroalbuminuria as diagnostic criteria for CKD independent of eGFR.<\/jats:p>","DOI":"10.3390\/medicina61050843","type":"journal-article","created":{"date-parts":[[2025,5,4]],"date-time":"2025-05-04T20:57:16Z","timestamp":1746392236000},"page":"843","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["The Underdiagnosis of Chronic Kidney Disease in Patients with a Documented Estimated Glomerular Filtration Rate and\/or Urine Albumin\u2013Creatinine Ratio in Germany"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2124-7227","authenticated-orcid":false,"given":"Karel","family":"Kostev","sequence":"first","affiliation":[{"name":"IQVIA, Epidemiology, 60549 Frankfurt am Main, Germany"},{"name":"University Hospital, Philipps University of Marburg, 35043 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Lang","sequence":"additional","affiliation":[{"name":"IQVIA, Real World Commercial Analytics, 60549 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven-Oliver","family":"Tr\u00f6bs","sequence":"additional","affiliation":[{"name":"Boehringer Ingelheim Pharma GmbH & Co. KG, Market Access, 55218 Ingelheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Urbisch","sequence":"additional","affiliation":[{"name":"Boehringer Ingelheim Pharma GmbH & Co. KG, TA CRM Medicine, 55218 Ingelheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8860-9675","authenticated-orcid":false,"given":"Maximilian","family":"Gabler","sequence":"additional","affiliation":[{"name":"Boehringer Ingelheim Pharma GmbH & Co. KG, TA CRM Medicine, 55218 Ingelheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e342","DOI":"10.1016\/S2214-109X(24)00050-0","article-title":"The major global burden of chronic kidney disease","volume":"12","author":"Jadoul","year":"2024","journal-title":"Lancet Glob. Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1159\/000368499","article-title":"Regional variation of chronic kidney disease in Germany: Results from two population-based surveys","volume":"40","author":"Aumann","year":"2015","journal-title":"Kidney Blood Press Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2135","DOI":"10.1681\/ASN.2015050542","article-title":"CKD Prevalence Varies across the European General Population","volume":"27","author":"Stel","year":"2016","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Stolpe, S., Kowall, B., Scholz, C., Stang, A., and Blume, C. (2021). High Unawareness of Chronic Kidney Disease in Germany. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182211752"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"23743735241256464","DOI":"10.1177\/23743735241256464","article-title":"Improving the Detection and Management of Kidney Health in Primary Care","volume":"11","author":"Robson","year":"2024","journal-title":"J. Patient Exp."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2024). KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int., 105, S117\u2013S314.","DOI":"10.1016\/j.kint.2023.10.018"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.diabet.2012.08.004","article-title":"Prevalence, screening and treatment of chronic kidney disease in people with type 2 diabetes in France: The ENTRED surveys (2001 and 2007)","volume":"38","author":"Assogba","year":"2012","journal-title":"Diabetes Metab."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2025","DOI":"10.2337\/dc21-0723","article-title":"Chronic Kidney Disease Testing Among At-Risk Adults in the U.S. Remains Low: Real-World Evidence From a National Laboratory Database","volume":"44","author":"Alfego","year":"2021","journal-title":"Diabetes Care"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"(2024). Wanner C, Schaeffner E, Frese T, Weber C, Stahl P, Scherg F, Burckhardt F, Opfermann U, Radowsky F, Mader F. InspeCKD-Analysis of the use of diagnostics in patients at high risk for chronic kidney disease in German general practitioner (GP) practices. MMW Fortschr. Med., 166, 9\u201317.","DOI":"10.1007\/s15006-024-3684-y"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Szczech, L.A., Stewart, R.C., Su, H.L., DeLoskey, R.J., Astor, B.C., Fox, C.H., McCullough, P.A., and Vassalotti, J.A. (2014). Primary care detection of chronic kidney disease in adults with type-2 diabetes: The ADD-CKD Study (awareness, detection and drug therapy in type 2 diabetes and chronic kidney disease). PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0110535"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Diamantidis, C.J., Hale, S.L., Wang, V., Smith, V.A., Scholle, S.H., and Maciejewski, M.L. (2019). Lab-based and diagnosis-based chronic kidney disease recognition and staging concordance. BMC Nephrol., 20.","DOI":"10.1186\/s12882-019-1551-3"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1136\/jech-2019-212858","article-title":"Undiagnosed and untreated chronic kidney disease and its impact on renal outcomes in the Japanese middle-aged general population","volume":"73","author":"Yamada","year":"2019","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Wagner, M., Wanner, C., Schich, M., Kotseva, K., Wood, D., Hartmann, K., Fette, G., R\u00fccker, V., Oezkur, M., and St\u00f6rk, S. (2017). Patient\u2019s and physician\u2019s awareness of kidney disease in coronary heart disease patients-a cross-sectional analysis of the German subset of the EUROASPIRE IV survey. BMC Nephrol., 18.","DOI":"10.1186\/s12882-017-0730-3"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/nep.13459","article-title":"Raising awareness, screening and prevention of chronic kidney disease: It takes more than a village","volume":"23","author":"Hsiao","year":"2018","journal-title":"Nephrology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e067386","DOI":"10.1136\/bmjopen-2022-067386","article-title":"Prevalence of undiagnosed stage 3 chronic kidney disease in France, Germany, Italy, Japan and the USA: Results from the multinational observational REVEAL-CKD study","volume":"13","author":"Tangri","year":"2023","journal-title":"BMJ Open"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"100438","DOI":"10.1016\/j.lanepe.2022.100438","article-title":"Prevalence, outcomes, and cost of chronic kidney disease in a contemporary population of 24 million patients from 11 countries: The CaReMe CKD study","volume":"20","author":"Bodegard","year":"2022","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e1918169","DOI":"10.1001\/jamanetworkopen.2019.18169","article-title":"Clinical Characteristics of and Risk Factors for Chronic Kidney Disease Among Adults and Children: An Analysis of the CURE-CKD Registry","volume":"2","author":"Tuttle","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1161\/CIRCULATIONAHA.120.050686","article-title":"Cardiovascular Disease in Chronic Kidney Disease: Pathophysiological Insights and Therapeutic Options","volume":"143","author":"Jankowski","year":"2021","journal-title":"Circulation"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"459","DOI":"10.5414\/CP203320","article-title":"Basic characteristics and representativeness of the German Disease Analyzer database","volume":"56","author":"Rathmann","year":"2018","journal-title":"Int. J. Clin. Pharmacol. Ther."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1055\/a-0581-4870","article-title":"Frequency of Blood Pressure and Estimated Glomerular Filtration Rate Testing in Type 2 Diabetes Mellitus: A Retrospective Study with 43,509 Patients","volume":"127","author":"Kostev","year":"2019","journal-title":"Exp. Clin. Endocrinol. Diabetes"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1186\/s40001-023-01114-6","article-title":"Non-alcoholic fatty liver disease (NAFLD) is associated with an increased incidence of chronic kidney disease (CKD)","volume":"28","author":"Roderburg","year":"2023","journal-title":"Eur. J. Med. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1007\/s00125-008-1086-9","article-title":"Performance of the revised \u2018175\u2032 Modification of Diet in Renal Disease equation in patients with type 2 diabetes","volume":"51","author":"Chudleigh","year":"2008","journal-title":"Diabetologia"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e197","DOI":"10.18295\/2075-0528.1572","article-title":"Comparison between Three Different Equations for the Estimation of Glomerular Filtration Rate in Omani Patients with Type 2 Diabetes Mellitus","volume":"14","year":"2014","journal-title":"Sultan Qaboos Univ. Med J."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Tanaka, T., Maruyama, S., Chishima, N., Akiyama, H., Shimamoto, K., Inokuchi, S., Yokota, K., and Ozaki, A. (2024). Population characteristics and diagnosis rate of chronic kidney disease by eGFR and proteinuria in Japanese clinical practice: An observational database study. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-55827-7"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1159\/000489897","article-title":"Disparities in Chronic Kidney Disease Prevalence among Males and Females in 195 Countries: Analysis of the Global Burden of Disease 2016 Study","volume":"139","author":"Bikbov","year":"2018","journal-title":"Nephron"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s00508-022-02074-3","article-title":"Chronic kidney disease is more prevalent among women but more men than women are under nephrological care: Analysis from six outpatient clinics in Austria 2019","volume":"135","author":"Lewandowski","year":"2023","journal-title":"Wien. Klin. Wochenschr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1038\/s41581-023-00784-z","article-title":"Differences in the epidemiology, management and outcomes of kidney disease in men and women","volume":"20","author":"Chesnaye","year":"2024","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e4","DOI":"10.1093\/eurjpc\/zwaa095","article-title":"Association between albuminuria, incident cardiovascular events, and mortality in persons without hypertension, diabetes, and cardiovascular disease","volume":"29","author":"Nowak","year":"2022","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"The EMPA-KIDNEY Collaborative Group (2023). Empagliflozin in Patients with Chronic Kidney Disease. N. Engl. J. Med., 388, 117\u2013127.","DOI":"10.1056\/NEJMoa2204233"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1056\/NEJMoa2024816","article-title":"Dapagliflozin in Patients with Chronic Kidney Disease","volume":"383","author":"Heerspink","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2295","DOI":"10.1056\/NEJMoa1811744","article-title":"Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy","volume":"380","author":"Perkovic","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Mavrakanas, T.A., Tsoukas, M.A., Brophy, J.M., Sharma, A., and Gariani, K. (2023). SGLT-2 inhibitors improve cardiovascular and renal outcomes in patients with CKD: A systematic review and meta-analysis. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-42989-z"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3058","DOI":"10.1111\/dom.15623","article-title":"Real-world effectiveness of sodium-glucose cotransporter-2 inhibitors on the progression of chronic kidney disease in patients without diabetes, with and without albuminuria","volume":"26","author":"Nakhleh","year":"2024","journal-title":"Diabetes Obes. Metab."},{"key":"ref_34","unstructured":"EMPA-KIDNEY Collaborative Group (2024). Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: Secondary analyses of the Empa-Kidney trial. Lancet Diabetes Endocrinol., 12, 51\u201360."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1186\/s12933-024-02279-y","article-title":"Incident heart failure and the subsequent risk of progression to end stage kidney disease in individuals with type 2 diabetes","volume":"23","author":"Liu","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e002332","DOI":"10.1136\/openhrt-2023-002332","article-title":"Risk factors, outcomes and healthcare utilisation in individuals with multimorbidity including heart failure, chronic kidney disease and type 2 diabetes mellitus: A national electronic health record study","volume":"10","author":"Pasea","year":"2023","journal-title":"Open Heart"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/s12020-016-1014-6","article-title":"Diabetes mellitus as a risk factor for incident chronic kidney disease and end-stage renal disease in women compared with men: A systematic review and meta-analysis","volume":"55","author":"Shen","year":"2017","journal-title":"Endocrine"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1111\/dom.14916","article-title":"Chronic kidney disease begets heart failure and vice versa: Temporal associations between heart failure events in relation to incident chronic kidney disease in type 2 diabetes","volume":"25","author":"Wu","year":"2023","journal-title":"Diabetes Obes. Metab."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.1159\/000328015","article-title":"Microalbuminuria: Marker or maker of cardiovascular disease","volume":"119","author":"Abdelhafiz","year":"2011","journal-title":"Nephron. Exp. Nephrol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2100","DOI":"10.1681\/ASN.2006050517","article-title":"Microalbuminuria as an early marker for cardiovascular disease","volume":"17","author":"Parving","year":"2006","journal-title":"J. Am. Soc. Nephrol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/5\/843\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:26:28Z","timestamp":1760030788000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/5\/843"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,2]]},"references-count":40,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["medicina61050843"],"URL":"https:\/\/doi.org\/10.3390\/medicina61050843","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,2]]}}}