Chronic Kidney Disease in Balkan Countries—A Call to Action for Timely Diagnosis and Monitoring
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Epidemiology
3.1.1. Current Status
3.1.2. Call to Action
- Design and implement an epidemiology study across the Balkan region to collect standardized data on the incidence and prevalence of early stages and causes of CKD. A unique research protocol and uniform data collection and reporting would allow building real-world evidence across the Balkan region, further exploring the variability across countries and informing management strategies based on reliable data.
- Expand existing reporting protocols and registries to include all CKD patients, irrespective of stage of the disease.
- Discuss possibilities to extract retrospective data (serum creatinine and albuminuria) from electronic files and use them as benchmark for epidemiology studies.
3.2. Risk Factors and Disease Awareness
3.2.1. Current Status
3.2.2. Call to Action
- Advocate for development and implementation of professional awareness campaigns for patients and medical professional communities.
- Increase media presence of national key opinion leaders to enhance education regarding primary and secondary prevention of CKD.
- Address specifically high-risk populations and collaborate with patient organizations and medical societies to improve recognition of chronic conditions that are risk factors for CKD.
- Promote a unitary and coherent communication strategy to European and national professional societies to streamline education of their members during regular scientific meetings and webinars.
3.3. Diagnosis and Treatment
3.3.1. Current Status
3.3.2. Call to Action
- Develop and implement screening programs in high-risk populations to allow diagnosis in early stages and adequate management to slow the decline of renal function (Figure 1).
- Develop simple algorithms for risk assessment, diagnosis, and referral to nephrologists.
- Include CKD risk assessment and diagnostic criteria in all relevant communications, and scientific meetings and webinars.
- Promote reporting on laboratory results of eGFR and UACR/UPCR in all patients with serum creatinine and albuminuria or proteinuria assessment.
- Create multidisciplinary working groups (nephrologist, endocrinologist, cardiologist, PCP) to coordinate implementation of CKD-related activities and lead high-level discussions to include CKD on the agenda of decision makers.
- ○
- Create the framework for structured collaboration of multidisciplinary team in national and regional kidney networks
- ○
- Empower PCPs to initiate and monitor treatment in CKD
- ○
- Increase number of nephrologists to treat CKD in all stages
- ○
- Provide reimbursement of treatments with strong and reliable results on mortality and renal function
- ○
- Share best practices of diagnosis and treatment between countries and institutions
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- Collaborate with specialists in pharmaco-economics to assess the cost-effectiveness of early diagnosis and timely treatment in CKD
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Country/Region | |||
---|---|---|---|
Bulgaria | Count | Age-Standardized Rate per 100,000 | Percentage Change in Age-Standardized Rates between 1990 and 2017 |
Prevalence (95% UI) | |||
981,339 (909,610 to 1,061,687) | 8000 (7420 to 8630) | 2.6% (−0.7 to 5.9) | |
Croatia | 562,778 (520,865 to 610,153) | 7779 (7206 to 8390) | 1.2% (−3.1 to 6.2) |
Serbia | 1,142,513 (1,063,208 to 1,237,929) | 8421 (7846 to 9069) | −0.5% (−4.1 to 3.3) |
Slovenia | 266,527 (247,205 to 289,578) | 7581 (7056 to 8179) | −1.1% (−5.7 to 3.2) |
Central Europe | 13,951,402 (12,930,450 to 15,136,020) | 7659 (7115 to 8282) | −2.7% (−6.2 to 1.4) |
Mortality (95% UI) | |||
Bulgaria | 1447 (1346 to 1557) | 10.1 (9.4 to 10.8) | 45.7% (35.3 to 57.2) |
Croatia | 829 (776 to 888) | 8.8 (8.2 to 9.4) | 35.3% (25.6 to 46.0) |
Serbia | 2386 (1982 to 2607) | 14.8 (12.4 to 16.1) | 18.8% (7.3 to 32.0) |
Slovenia | 213 (195 to 232) | 4.4 (4.0 to 4.8) | −30.2% (−36.7 to −23.1) |
Central Europe | 16,284 (15,806 to 16,706) | 7.5 (7.3 to 7.7) | −21.2% (−23.6 to −18.9) |
A. Diagnosis of CKD | |
One or more markers of kidney damage present for >3 months |
|
OR | |
eGFR <60 mL/min/1.73 m2 persistently present >3 months | |
B. Staging of CKD | |
Stage | eGFR values (mL/min/1.73 m2) |
G1 | ≥90 |
G2 | 60–89 |
G3a | 45–59 |
G3b | 30–44 |
G4 | 15–29 |
G5 | <15 |
Challenges in Diagnosis |
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|
Challenges in Treatment |
|
Gaps in the Referral Pathway |
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Mitić, I.; Laganović, M.; Marinova, I.; Gancheva, N.; Nakić, V.; Melentijevic, D.; Paskalev, E.; Vajd, R.; Škoberne, A. Chronic Kidney Disease in Balkan Countries—A Call to Action for Timely Diagnosis and Monitoring. Diagnostics 2022, 12, 2162. https://doi.org/10.3390/diagnostics12092162
Mitić I, Laganović M, Marinova I, Gancheva N, Nakić V, Melentijevic D, Paskalev E, Vajd R, Škoberne A. Chronic Kidney Disease in Balkan Countries—A Call to Action for Timely Diagnosis and Monitoring. Diagnostics. 2022; 12(9):2162. https://doi.org/10.3390/diagnostics12092162
Chicago/Turabian StyleMitić, Igor, Mario Laganović, Ivelina Marinova, Nina Gancheva, Valentina Nakić, Dragana Melentijevic, Emil Paskalev, Rajko Vajd, and Andrej Škoberne. 2022. "Chronic Kidney Disease in Balkan Countries—A Call to Action for Timely Diagnosis and Monitoring" Diagnostics 12, no. 9: 2162. https://doi.org/10.3390/diagnostics12092162
APA StyleMitić, I., Laganović, M., Marinova, I., Gancheva, N., Nakić, V., Melentijevic, D., Paskalev, E., Vajd, R., & Škoberne, A. (2022). Chronic Kidney Disease in Balkan Countries—A Call to Action for Timely Diagnosis and Monitoring. Diagnostics, 12(9), 2162. https://doi.org/10.3390/diagnostics12092162