Identifying chronic kidney disease in an emergency department: a chance for an early diagnosis

INTRODUCTION: Chronic kidney disease (CKD) has relatively asymptomatic course, but even at its onset, it worsens the prognosis of patients, mainly because of the increased risk of cardiovascular diseases. Several population‑based screening programs as well as initiatives focused on certain risk groups were undertaken to better diagnose early stages of CKD. It appears that an emergency department (ED) of a hospital may be the right place to screen for early CKD. OBJECTIVES: The aim of the study was to assess the accuracy of ED practices in the detection of CKD. PATIENTS AND METHODS: The study involved 176 subjects who presented at the ED over 1 month and were subsequently admitted to one of the wards at the general hospital. Blood pressure on admission was recorded in 61% of the patients; serum creatinine and estimated glomerular filtration rate (eGFR) were measured in 50% of the subjects, urea in 42.2%, potassium in 87.5%, and glucose in 82%. Patients with previously diagnosed CKD were excluded from the study. RESULTS: Sixty‑three per cent of blood pressure values exceeded 140/90 mmHg, 27.3% of all creatinine samples exceeded the upper limit of 1.2 mg/dl, and 64.8% of eGFR results were below 90 ml/min/1.73 m2 (mean 78 ±36 ml/min/1.73 m2). Abnormal levels of urea (>50 mg/dl) were observed in 32% of the patients. Potassium levels were within the reference range in 81.5% of the patients (3.5–5.0 mmol/l; only 10.4% exceeding 5 mmol/l). Elevated glucose levels (>110 mg/dl) were observed in 60% of the patients. CONCLUSIONS: ED practices could be used to identify a significant number of patients with undiagnosed CKD. However, these simple, widely available, and cost‑effective methods of early CKD detection are underused. Our results show that there is an urgent need for a structural screening program for CKD at the level of ED.