Clinical characteristics and renal risk of patients with chronic kidney disease: real-world evidence from the icareme global registry

Abstract Background and Aims Chronic kidney disease (CKD) has emerged as a leading global public health concern due to its growing prevalence and associated morbidity and mortality. Throughout the disease progression, CKD is associated with a substantial health and socio-economic burden on patients, families, and healthcare systems worsened by complex interactions with type 2 diabetes (T2D), hypertension (HTN), and heart failure (HF). To help current and future patients get the best possible care, it is of the greatest importance to better understand how they are managed routinely, but real-world data on coexisting cardiovascular, renal, and metabolic diseases are scarce or non-existent in many countries. The iCaReMe Global Registry aims to address these knowledge gaps by providing observational data on patients’ characteristics, risk factors, management patterns, disease progression, and outcomes related to CKD and associated comorbidities namely: T2D, HTN, and HF. Method The iCaReMe Global Registry (NCT03549754) is a prospective, investigator-led, multinational, observational registry relying on voluntary participation by treating physicians to assess the management and quality of care through socio-demographic and clinical characteristics, disease management patterns (including screening, diagnosis, treatment approaches), healthcare resource utilization and clinical outcomes in patients with CKD, T2D, HTN, and/or HF. Eligible and consented patients were enrolled during routine clinical practice based on the physician's discretion and were followed up per routine clinical care. We present the descriptive analysis of baseline clinical and demographic characteristics of the CKD cohort enrolled in the iCaReMe Global Registry from February 2018 to December 2022. Results Overall 2977 patients with CKD have been enrolled from 21 countries (Argentina, Costa Rica, Egypt, Ethiopia, Georgia, Greece, Hong Kong, Indonesia, India, Jordan, Kenya, Lebanon, Malaysia, Mexico, Russia, South Africa, Thailand, The Philippines, Turkey, Ukraine, and the United Arab Emirates). At baseline, the mean ± standard deviation (SD) age was 60.4 ± 13.8 years and 54.6% were males. The mean ± SD systolic and diastolic blood pressures of the cohort were 120.4 ± 43.6 and 70.5 ± 25.6 mmHg and the mean ± SD body mass index was 21.6 ± 12.9 kg/m2. 68.9% had T2D and 68.3% had hypertension. Diabetic kidney disease and hypertensive kidney disease were the most common etiologies in 78.8% of the patients (Figure 2). Serum creatinine was reported in 85.3% of patients and urine albumin-creatinine ratio (UACR) in 30.5% and only 25.9% had both. The prevalence of KDIGO GFR categories G3-5 based on estimated glomerular filtration rate (eGFR) using CKD-EPI was 72.5% and the prevalence of albuminuria A2/A3 was 75.9%. In total, 7.9% patients were undergoing dialysis. In patients with T2D (n = 2051); 69.1% (1250/1808) had G3-5 GFR category and 76.1% (484/636) had albuminuria stage A2 and A3. In patients with HTN (n = 2033); 77.6% (1367/1761) had G3-5 GFR category and 76.6% (485/633) had albuminuria stage A2 and A3. Conclusion At baseline most of iCaReMe Registry CKD cohort fall within the KDIGO high or very high risk of outcomes associated with a high prevalence of T2D and HTN. Our results also indicate an underutilization of albuminuria testing despite its critical role in diagnosis, risk stratification and follow up which raises concerns about CKD early detection, management, and prognosis.