Dr Lucy Wynter1,4, Dr Brendan Smyth2, Dr John Saunders, Carmen Moroney, Dr Lilijana Gorringe1, Kylie Turner, Dr Sreeram Venugopal, Dr Leyla Aouad, Lisa Tienstra, Rowena Monteverde, Dr Shaundeep Sen1, Dr Amy Kang3, Dr Melanie Wyld6, Professor George Mangos5, Professor Steve Chadban4
1Concord Clinical School, University of Sydney, , Australia, 2The NHMRC Clinical Trials Centre, University of Sydney, , Australia, 3The George Institute, , Australia, 4Charles Perkins Centre, University of Sydney, , Australia, 5School of Medicine and Health, University of NSW, , Australia, 6School of Public Health, FMH, University of Sydney, , Australia
Biography:
Dr Lucy Wynter is a Clinical Academic Nephrologist with the University of Sydney, Concord Clinical School and Concord and Canterbury Hospitals. She is the clinical lead for the CKD Stewardship program
Aim:
To compare the prevalence of un-recognised mid to late-stage chronic kidney disease (CKD) in hospitalised patients in two large urban health districts.
Background:
CKD affects 14% of adults in Australia and is frequently under-recognised, and so diagnosed in late stages when opportunities to prevent progression to kidney failure have been missed. Existing early identification programs target primary care or specific high-risk populations. We describe the first Australian study of systematic, opportunistic case detection of CKD in hospitalised patients.
Methods:
We prospectively reviewed the electronic medical record (eMR) of patients admitted to Sydney Local Health District (SLHD, n=47,558) and South East Sydney Local Health District (SESLHD, n=44,881) Hospitals between March 2024-March 2025. Eligible participants were non-pregnant adults aged 18-80, with an admission eGFR<45ml/min/1.73m2. Participants with dementia, from a nursing home, receiving palliative care, admitted under or known to a nephrologist, or with acute kidney injury were excluded.
Results:
Among all admissions, 483 (1.0%) and 473 (1.1%) had an eGFR<45ml/min/1.73m2 and met eligibility criteria in SLHD and SESLHD respectively, with a median age of 75. Of these, CKD was documented on admission in 23.6% v 24.7% and Urine ACR available 5.2% v 6.3% in SLHD and SESLHD respectively. Patient comorbidities included diabetes (41.2% v 40.2%), hypertension (80.1% v 6.1%), heart failure (26.5% v17.5%), coronary artery disease (35.6% v 33.6%) and obesity (40.4% v 40.2%) across SLHD and SESLHD respectively. Prescription of SGLT2i (17% v 17.1%) ACEi/ARB (52.2% v 43.3%) and statins (61.5% v 54.5%) were similar.
Conclusion:
Hospital admission represents a unique opportunity to identify undiagnosed and/or undertreated patients with mid to late-stage CKD. Interventions designed to detect and better manage this population warrant further investigation.
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