“The Disease Awareness Innovation Network” for chronic kidney disease identification in general practice

Background The “awareness gap” and the under-recognition of chronic kidney disease (CKD) by general practitioners (GPs) is well documented. We set a framework to evaluate the impact in primary care of targeted training and networking with nephrologists with regard to CKD awareness in terms of potential increase of the proportion of patients classified according to KDIGO in the general population and in patients with diabetes, hypertension and heart failure. Methods Data were extracted from the Millewin Digital Platform in use by the GPs (N = 17) at baseline (T0, N = 17,854) and after 6 months (T6, N = 18,662) of networking (education, instant messaging and selected joint visits) with nephrolo- gists (N = 2). The following variables were extracted: age, sex, eGFR (estimated glomerular filtration rate), ACR (urinary albumin-to-creatinine ratio), presence of type 2 diabetes, hypertension and heart failure. The proportion of patients detected having an eGFR below 60 mL/min/1.73m2 was also reported as deemed clinically relevant. Results We observed an increase in the use of ACR and eGFR tests in the entire cohort (+ 121% and + 73%, respectively) and in patients with comorbidities. The proportion of patients with eGFR < 60 mL/min/1.73m2 significantly increased from 2.2% to 3.8% in the entire cohort, from 6.3% to 12.7% in patients with diabetes, and from 5.6% to 9.9% in those with hyper- tension and finally from 10.8% to 23.7% in patients with heart failure. Conclusions Training and network support to GPs by nephrologists can improve CKD awareness and increase its identifica- tion in the general population and, even more, in categories at risk.