Screening and management of hypertensive patients with chronic kidney disease referred to Hypertension Excellence Centres among 27 countries. A pilot survey based on questionnaire.
Antihypertensive Agents; Humans; Surveys and Questionnaires; Male; Female; Pilot Projects; Referral and Consultation; Antihypertensive Agents/therapeutic use; Middle Aged; Mass Screening/methods; Europe; Aged; Glomerular Filtration Rate; Renal Insufficiency, Chronic/complications; Renal Insufficiency, Chronic/physiopathology; Hypertension/drug therapy; Hypertension/complications; albuminuria; chronic kidney disease; hypertension; management; screening; Mass Screening; Renal Insufficiency, Chronic; Internal Medicine; Physiology; Cardiology and Cardiovascular Medicine
Abstract :
[en] [en] OBJECTIVE: Real-life management of hypertensive patients with chronic kidney disease (CKD) is unclear.
METHODS: A survey was conducted in 2023 by the European Society of Hypertension (ESH) to assess management of CKD patients referred to ESH-Hypertension Excellence Centres (ESH-ECs) at first referral visit. The questionnaire contained 64 questions with which ESH-ECs representatives were asked to estimate preexisting CKD management quality.
RESULTS: Overall, 88 ESH-ECs from 27 countries participated (fully completed surveys: 66/88 [75.0%]). ESH-ECs reported that 28% (median, interquartile range: 15-50%) had preexisting CKD, with 10% of them (5-30%) previously referred to a nephrologist, while 30% (15-40%) had resistant hypertension. The reported rate of previous recent (<6 months) estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) testing were 80% (50-95%) and 30% (15-50%), respectively. The reported use of renin-angiotensin system blockers was 80% (70-90%). When a nephrologist was part of the ESH-EC teams the reported rates SGLT2 inhibitors (27.5% [20-40%] vs. 15% [10-25], P = 0.003), GLP1-RA (10% [10-20%] vs. 5% [5-10%], P = 0.003) and mineralocorticoid receptor antagonists (20% [10-30%] vs. 15% [10-20%], P = 0.05) use were greater as compared to ESH-ECs without nephrologist participation. The rate of reported resistant hypertension, recent eGFR and UACR results and management of CKD patients prior to referral varied widely across countries.
CONCLUSIONS: Our estimation indicates deficits regarding CKD screening, use of nephroprotective drugs and referral to nephrologists before referral to ESH-ECs but results varied widely across countries. This information can be used to build specific programs to improve care in hypertensives with CKD.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Halimi, Jean-Michel; Service de Néphrologie-Hypertension, Dialyses, Transplantation rénale, Hôpital Bretonneau, CHU Tours, Tours, France
Sarafidis, Pantelis; School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
Azizi, Michel; Université Paris Cité, Paris, France, APHP, Service d'Hypertension Artérielle, Hôpital Européen Georges Pompidou, Paris, France
Bilo, Grzegorz; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
Burkard, Thilo; Medical Outpatient Department and Hypertension Clinic, University Hospital Basel, Basel, Switzerland
Bursztyn, Michael; Hypertension Clinic, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, and Faculty of Medicine, Hadassah-Hebrew University, School of Medicine, Jerusalem, Israel
Camafort, Miguel; Hypertension Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Spain
Chapman, Neil; Peart-Rose Clinic, Hammersmith Hospital, Imperial College Healthcare Trust, London, UK
Cottone, Santina; PROMISE Department, Nephrology and Dialysis Unit with Hypertension ESH Excellence Centre, University Hospital P. Giaccone, University of Palermo, Palermo, Italy
de Backer, Tine; Department of Cardiovascular Diseases, Internal Medicine, University Hospital Ghent, Ghent, Belgium
Deinum, Jaap; Department of Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
Delmotte, Philippe; Hypertension Unit (European Society of Hypertension Excellence Centre), Department of Cardiology, HELORA University Hospitals, Mons, Belgium
Dorobantu, Maria; Emergency Clinical Hospital of Bucharest, Bucharest, Romania
Doumas, Michalis; 2nd Prop. Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
Duly-Bouhanick, Béatrice; Service d'HTA et Therapeutique CHU Rangueil, Toulouse University, Toulouse
Fauvel, Jean-Pierre; Hôpital Ed Herriot Department of Nephrology and Hypertension, Lyon
Fesler, Pierre; Department of Internal Medicine, Montpellier University Hospital, Montpellier, France and PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, Montpellier, France
Gaciong, Zbigniew; Medical University of Warsaw, Warsaw, Poland
Gkaliagkousi, Eugenia; 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Greece
Gordin, Daniel; Department of Nephrology, Helsinki University Hospital and University of Helsinki, Biomedicum 2 Helsinki, Helsinki, Finland
Grassi, Guido; Clinica Medica, University Milano Bicocca, Milan Italy
Grassos, Charalampos; Hypertension Unit, KAT General Hospital of Attica, Attica, Greece
Guerrot, Dominique; Service de Néphrologie, CIC-CRB 1404, INSERM EnVi U1096, CHU Rouen, Rouen, France
Huart, Justine ; Université de Liège - ULiège > Département des sciences cliniques > Néphrologie
Izzo, Raffaele; Department of Advanced Medical Sciences, Federico II University of Naples, Naples, Italy
Águila, Fernando Jaén; Vascular Risk Unit, Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain
Járai, Zoltán; South-Buda Center Hospital, St. Imre University Teaching Hospital, Budapest, Hungary
Kahan, Thomas; Karolinska Institutet, Department of Clinical Sciences, Division of Cardiovascular Medicine, Stockholm, Sweden, and Danderyd University Hospital Corp, Department of Cardiology, Stockholm, Sweden
Kantola, Ilkka; Division of Medicine Turku University Hospital, Turku University, Turku, Finland
Kociánová, Eva; First Department of Internal Medicine - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
Limbourg, Florian P; Hypertension Center, Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
Lopez-Sublet, Marilucy; AP-HP, Unité d'hypertension artérielle, service de médecine interne, Hôpital Avicenne, Bobigny, France
Mallamaci, Francesca; Grande Ospedale Metropolitano, UOC di Nefrologia abilitata al trapianto renale, CNR Epidemiologia Clinica e Fisiopatologia delle Malattie Renali e dell'Ipertensione Arteriosa, Reggio Calabria, Italy
Marketou, Maria; Hypertension Outpatient Clinic, Cardiology Department, Heraklion University General Hospital, Heraklion, Crete, Greece
Mayer, Gert; Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Austria
Mazza, Alberto; UOC Medicina Interna, Centro Ipertensione di Eccellenza Europea ESH, Azienda ULSS 5 Polesana - Ospedale di Adria (RO), Italy
MacIntyre, Iain M; Cardiovascular Risk Clinic, Western General Hospital, Edinburgh, UK
Mourad, Jean-Jacques; Service de Médecine Interne, Hôpital Franco-Britannique, Levallois-Perret, France
Muiesan, Maria Lorenza; Department of Clinical and Experimental Sciences, University of Brescia and ASST Spedali Civili, Italy
Nasr, Edgar; St George University Medical Center, Achrafieh-Beirut, Lebanon
Nilsson, Peter; Department of Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden
Oliveras, Anna; Hypertension and Vascular Risk Unit, Department of Nephrology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
Ormezzano, Olivier; UF Hypertension et Athérothrombose, Centre Européen d'Excellence en Hypertension Artérielle, Service de Cardiologie, Pôle Thorax et Vaisseaux, CHU Michallon, Grenoble, France
Paixão-Dias, Vitor; Hospital Centre of Vila Nova de Gaia/Espinho, Internal Medicine Department, Hypertension and Cardiometabolic Risk Unit, ESH Excellence Centre, Vila Nova de Gaia, Portugal
Papadakis, Ioannis; Hypertension Unit, Department of Internal Medicine, University Hospital of Heraklion, Heraklion
Papadopoulos, Dimitris; ESH Excellent Center Hypertension, LAIKO University Hospital, Athens, Greece
Perl, Sabine; Department of Cardiology, Medical University of Graz, Graz, Austria
Polónia, Jorge; Faculty of Medicine Oporto, Portugal
Pontremoli, Roberto; Clinica di Medicina Interna 2, Università degli Studi e IRCCS Ospedale Policlinico San Martino di Genova
Pucci, Giacomo; Department of Medicine and Surgery - University of Perugia Unit of Internal Medicine - Santa Maria Terni Hospital, Terni, Italy
Robles, Nicolás Roberto; Hospital Universitario de Badajoz, Badajoz, Spain
Rubin, Sébastien; Service de Néphrologie -transplantation-dialyse-aphérèses, CHU Bordeaux, France
Ruilope, Luis Miguel; Cardiovascular Risk and Hypertension Hospital, Madrid, Spain
Rump, Lars Christian; Department of Internal Medicine/ Nephrology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
Saeed, Sahrai; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
Sanidas, Elias; Department of Cardiology, LAIKO General Hospital, Athens, Greece
Sarzani, Riccardo; Università Politecnica delle Marche and IRCCS-INRCA, Ancona, Italy
Schmieder, Roland; Department of Nephrology and Hypertension University Hospital Erlangen, Friedrich Alexander University Erlangen/Nürnberg, Erlangen, Germany
Silhol, François; Service de cardiologie, Hôpital de la Timone, Marseille, France
Sokolovic, Sekib; Plava Medical Group, Sarajevo, Bosnia and Herzegovina
Solbu, Marit; University Hospital of North Norway, Tromsø, Norway
Soucek, Miroslav; 2nd Deparment od Internal Medicine of St. Anne's University Hospital Brno and Fakulty of Medicine Masaryk University, Brno, Czechia
Stergiou, George; Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
Sudano, Isabella; University Hospital Zurich University Heart Center, Cardiology and University of Zurich, Zurich, Switzerland
Tabbalat, Ramzi; Department of Cardiology, Abdali Hospital, Amman, Jordan
Tengiz, Istemihan; Izmir Medicana International Hospital, Division of Cardiology, Konak/Izmir, Turkey
Triantafyllidi, Helen; 2nd Department of Cardiology, Medical School, University of Athens, ATTIKON Hospital, Athens
Tsioufis, Konstontinos; 1st Department of Cardiology, National and Kapodistrian University of Athens, Hippocratio Hospital, Greece
Václavík, Jan; Department of Internal Medicine and Cardiology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Czech Republic
van der Giet, Markus; Charité - Universitätsmedizin Berlin, Medinische Klinik für Nephrologie und internistische Intensivtherapie, Berlin, Germany
Van der Niepen, Patricia; Universitair Ziekenhuis Brussel, VUB, Belgium
Veglio, Franco; Department of Medical Sciences, University of Turin, Turin, Italy
Venzin, Reto M; Department of Nephrology, Cantonal Hospital Graubuenden, Chur, Switzerland
Viigimaa, Margus; Centre of Cardiology, North Estonia Medical Centre, Tallinn University of Technology, Tallinn, Estonia
Weber, Thomas; Klinikum Wels-Grieskirchen
Widimsky, Jiri; Centre for Hypertension, IIIrd Internal Department, General Faculty Hospital, Charles University, Prague, Czech Republic
Wuerzner, Grégoire; Service de néphrologie et d'hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
Zelveian, Parounak; Center of Preventive Cardiology, Hospital N2 CJSC, Yerevan, Armenia
Zebekakis, Pantelis; Hypertension Unit of the First Department of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki
Lueders, Stephan; St. Josefs Hospital, Cloppenburg Germany
Persu, Alexandre; Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
Kreutz, Reinhold; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
Vogt, Liffert; Department of Internal Medicine, Section of Nephrology, Amsterdam University Medical Center, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
European Society of Hypertension Working Group on Hypertension, the Kidney
Screening and management of hypertensive patients with chronic kidney disease referred to Hypertension Excellence Centres among 27 countries. A pilot survey based on questionnaire.
Funding: The Survey was conducted through an unrestricted educational grant from AstraZeneca. The sponsor has had no involvement with the analyses and the development of the manuscript.
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