Clinical Nephrology - Lab methods and other markers

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Introduction and Aims: Advanced Chronic Kidney Disease (CKD) is gaining increasing medical and economical importance. However there is not enough reliable information about disease course, treatmentvariation, and the impact of treatments under routine clinical conditions on patient survival, quality of life, and costs. This paper demonstrates the first results of a nationwide electronicregistry, based on nephrology clinic data, for the prospective observation of CKD in Germany Methods: A large network of nephrologist practices across Germany (FNDN, Forschungsnetzwerk Verband Deutsche Nierenzentren ) is participating in the project. In each participating center, routinely obtained clinical data for non-dialysis dependent CKD patients are documented electronically including age, gender, cause of CKD, comorbidities, laboratory values, hospitalisations, blood pressure, and medications. Data are collected quarterly by a software called QuaNT (Qualitäsicherung Nephrologie und Transplantation). Results: Cross-sectional data are provided from 59 participating nephrology clinics and 6,187 patients with CKD Stage 3-5 in the second quarter of 2011. The mean age ± standard deviation (SD) was 72 ± 12 years. The distribution of CKD Stages 3, 4, and 5 (Non-dialysis) was 60, 33, and 8%, respectively. Diabetic nephropathy was diagnosed in 26% of patients; the major underlying renal disease was hypertension/vascular nephropathy with 47%. Renin- angiotensin-system (RAS) inhibitors were prescribed in 78% of all patients. Vitamin D prescription (any) was observed in 43%, phosphate binders in 5%, iron (oral or IV) in 19%, erythropoietin-stimulating agents (ESA) in 15%, and aldosterone antagonists (spironolactone) in 8% of patients. Conclusions: This nationwide registry is a new initiative that provides a nationwide electronic data base to prospectively follow clinical care and outcomes among CKD patients. The number of participating patients and practices is expected to increase considerably. Variations in patient care, as typically practiced, will be evaluated to identify best treatment practices in analyses integrated into the international Chronic Kidney Disease Outcomes and Practice Pattern Study (CKDopps). Table 1 Patient Characteristics, by Age Group and Overall * Patients with missing information for cause of CKD (17%) excluded