Journal Article

Impact of hospital-based early detection on management in chronic kidney disease: the CKD Stewardship study (CKD-S) – protocol for a prospective, multicentre, observational cohort study

Kang, Amy, Wynter, Lucinda Alix, Moroney, Carmen, Norris, Sarah, Saunders, John, Tienstra, Lisa, Aouad, Leyla, Mangos, George, Venugopal, Sreeram, Sen, Shaundeep, Monteverde, Rowena, Gorringe, Lilijana, Turner, Kylie, Smyth, Brendan, Chadban, Steven

2025

Overview

IntroductionChronic kidney disease (CKD) causes significant morbidity and mortality. Medical therapies can reduce the progression of disease by up to 50%. CKD is undiagnosed in the majority of people who have it, resulting in undertreatment. CKD Stewardship (CKD-S) aims to identify hospital inpatients with undiagnosed mid-stage to late-stage CKD with the goal of facilitating diagnosis and initiating guideline-based therapies.Methods and analysisThis prospective, multicentre, cohort study compares two models of care, CKD-S and standard care, for identification and management of CKD, across six public hospitals in metropolitan Sydney, Australia. CKD-S entails active case finding using the electronic medical record, with nephrologist outreach to admitting teams and kidney nurse provided patient education. Adult inpatients with an admission estimated glomerular filtration rate (eGFR)<45 mL/min/1.73 m2 and not known to a nephrologist will be eligible, excluding those with short life expectancy or advanced age (>80 years). Participants will be enrolled between 1 March 2024 and 1 March 2025. Baseline and demographic data will be collected after discharge from the hospital. Participants will be followed up 12 months after discharge using Pharmaceutical Benefits Schedule and Medical Benefits Schedule data, linked via the Australian Institute of Health and Welfare Hub. We will report the proportion of all adults admitted to the hospital who are not already known to a nephrologist, in which a diagnosis of stage 3b–5 CKD is recognised by the CKD-S intervention team, compared with standard care. We will then compare the proportion in each cohort who have an eGFR or urine albumin:creatinine ratio measured, are referred to a nephrologist, and are prescribed guideline-directed therapies over the 12 months following discharge from the hospital.Ethics and disseminationThe study has ethics approval from the Sydney Local Health District’s Ethics Committee (Concord Hospital Zone). The results of the CKD-S study will be published in peer-reviewed journals and presented at academic conferences.Trial registration numberACTRN12624000452594.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Australia / Blood pressure / Cardiovascular disease / Chronic renal failure / Cohort analysis / Diabetes / Early Diagnosis / End stage renal failure / Female / Glomerular Filtration Rate / Health services utilization / Hospitalization / Hospitals / Humans / Kidney diseases / Male / Mass Screening / Medical diagnosis / Mortality / Multicenter Studies as Topic / Nephrology / Observational studies / Observational Studies as Topic / Patients / Primary care / Prospective Studies / Protocol / Renal Insufficiency, Chronic - diagnosis / Renal Insufficiency, Chronic - therapy / Renal Medicine