Underdiagnosis, treatment pattern and awareness of chronic kidney disease in cardiovascular disease population: results from a national observational study in China

BACKGROUND: Chronic kidney disease (CKD) represents one of the most significant risk factors for adverse cardiovascular events and mortality. Data on real-world clinical practice of Chinese patients with CKD in the cardiology department is limited. OBJECTIVES: This study aims to investigate the proportion of underdiagnosis, guideline-directed therapy and awareness of CKD among Chinese patients. METHODS: It was a multicentre observational study conducted in 25 tertiary hospitals across China. Patients with two consecutive measurements (separated by 90-730 days) of either: (1) estimated glomerular filtration rate 20-60 mL/min/1.73 m², or (2) urinary albumin-to-creatinine ratio (UACR) ≥30 mg/g, with documented cardiology hospitalisation from 2022 to 2024 were eligible. Participants completed a lifestyle and awareness questionnaire after inclusion. The proportion of underdiagnosis, guideline-directed therapy and awareness of CKD was calculated. RESULTS: Among 2099 participants (median age 74.0 years; 64.6% male), 76.7% were underdiagnosed with CKD (lacked a CKD diagnostic code at discharge). Only 16.7% of participants underwent UACR testing and all individuals with isolated albuminuria (UACR >30 mg/g) remained underdiagnosed. Underdiagnosis was more common in patients aged 60-75, those with early-stage CKD, hospital stays <6 days or without comorbidities. The proportion of guideline-directed treatment was suboptimal: sodium-glucose cotransporter-2 inhibitors (36.5%), renin-angiotensin system inhibitors (56.5%) and only 32.2% of patients received guideline-directed treatment. CKD awareness lagged behind hypertension and diabetes, with <25% achieving guideline-recommended blood pressure and glycaemic targets. CONCLUSIONS: Alarmingly high proportion of underdiagnosed CKD, suboptimal guideline-directed treatment, and poor disease awareness of CKD in cardiology practice require urgent action. Closing these gaps is needed to reduce preventable cardiovascular morbidity and mortality.