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Journal Article Ppublish 5 citations

PubMed: 38747416 DOI: 10.1097/HJH.0000000000003756

Screening and management of hypertensive patients with chronic kidney disease referred to Hypertension Excellence Centres among 27 countries. A pilot survey based on questionnaire.

J Hypertens 42(9):1544-1554

Authors: Jean-Michel Halimi, Pantelis Sarafidis, Michel Azizi, Grzegorz Bilo, Thilo Burkard, Michael Bursztyn, Miguel Camafort, Neil Chapman, Santina Cottone, Tine de Backer, Jaap Deinum, Philippe Delmotte, Maria Dorobantu, Michalis Doumas, Rainer Dusing, Béatrice Duly-Bouhanick, Jean-Pierre Fauvel, Pierre Fesler, Zbigniew Gaciong, Eugenia Gkaliagkousi, Daniel Gordin, Guido Grassi, Charalampos Grassos, Dominique Guerrot, Justine Huart, Raffaele Izzo, Fernando Jaén Águila, Zoltán Járai, Thomas Kahan, Ilkka Kantola, Eva Kociánová, Florian P Limbourg, Marilucy Lopez-Sublet, Francesca Mallamaci, Athanasios Manolis, Maria Marketou, Gert Mayer, Alberto Mazza, Iain M MacIntyre, Jean-Jacques Mourad, Maria Lorenza Muiesan, Edgar Nasr, Peter Nilsson, Anna Oliveras, Olivier Ormezzano, Vitor Paixão-Dias, Ioannis Papadakis, Dimitris Papadopoulos, Sabine Perl, Jorge Polónia … and 35 other authors

Affiliations

  • Service de Néphrologie-Hypertension, Dialyses, Transplantation rénale, Hôpital Bretonneau, CHU Tours, Tours, France.
  • School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
  • Université Paris Cité, Paris, France; APHP, Service d'Hypertension Artérielle, Hôpital Européen Georges Pompidou, Paris, France.
  • Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
  • Medical Outpatient Department and Hypertension Clinic, University Hospital Basel, Basel, Switzerland.
  • Hypertension Clinic, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, and Faculty of Medicine, Hadassah-Hebrew University, School of Medicine, Jerusalem, Israel.
  • Hypertension Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Spain.
  • Peart-Rose Clinic, Hammersmith Hospital, Imperial College Healthcare Trust, London, UK.
  • PROMISE Department, Nephrology and Dialysis Unit with Hypertension ESH Excellence Centre, University Hospital P. Giaccone; University of Palermo, Palermo, Italy.
  • Department of Cardiovascular Diseases, Internal Medicine, University Hospital Ghent, Ghent, Belgium.
  • Department of Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
  • Hypertension Unit (European Society of Hypertension Excellence Centre), Department of Cardiology, HELORA University Hospitals, Mons, Belgium.
  • Emergency Clinical Hospital of Bucharest, Bucharest, Romania.
  • 2nd Prop. Department of Internal Medicine, Aristotle University, Thessaloniki, Greece.
  • Hypertoniezentrum Bonn, Schwerpunktpraxis Kardiologie, Angiologie, Prävention, Rehabilitation, Bonn, Germany.
  • Service d'HTA et Therapeutique CHU Rangueil, Toulouse University, Toulouse.
  • Hôpital Ed Herriot Department of Nephrology and Hypertension, Lyon.
  • Department of Internal Medicine, Montpellier University Hospital, Montpellier, France and PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, Montpellier, France.
  • Medical University of Warsaw, Warsaw, Poland.
  • 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Greece.
  • Department of Nephrology, Helsinki University Hospital and University of Helsinki, Biomedicum 2 Helsinki, Helsinki, Finland.
  • Clinica Medica, University Milano Bicocca, Milan Italy.
  • Hypertension Unit, KAT General Hospital of Attica, Attica, Greece.
  • Service de Néphrologie, CIC-CRB 1404, INSERM EnVi U1096, CHU Rouen, Rouen, France.
  • Division of Nephrology, University of Liège Hospital (ULg CHU), University of Liège, and Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Cardiovascular Sciences, University of Liège, Liège, Belgium.
  • Department of Advanced Medical Sciences, Federico II University of Naples, Naples, Italy.
  • Vascular Risk Unit, Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain.
  • South-Buda Center Hospital, St. Imre University Teaching Hospital, Budapest, Hungary.
  • Karolinska Institutet, Department of Clinical Sciences, Division of Cardiovascular Medicine, Stockholm, Sweden; and Danderyd University Hospital Corp, Department of Cardiology, Stockholm, Sweden.
  • Division of Medicine Turku University Hospital, Turku University, Turku, Finland.
  • First Department of Internal Medicine - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
  • Hypertension Center, Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.
  • AP-HP, Unité d'hypertension artérielle, service de médecine interne, Hôpital Avicenne, Bobigny, France.
  • 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.
  • Metropolitan Hospital, Piraeus.
  • Hypertension Outpatient Clinic, Cardiology Department, Heraklion University General Hospital, Heraklion, Crete, Greece.
  • Department of Internal Medicine IV (Nephrology and Hypertension); Medical University Innsbruck, Austria.
  • UOC Medicina Interna, Centro Ipertensione di Eccellenza Europea ESH, Azienda ULSS 5 Polesana - Ospedale di Adria (RO), Italy.
  • Cardiovascular Risk Clinic, Western General Hospital, Edinburgh, UK.
  • Service de Médecine Interne, Hôpital Franco-Britannique, Levallois-Perret, France.
  • Department of Clinical and Experimental Sciences, University of Brescia and ASST Spedali Civili, Italy.
  • St George University Medical Center, Achrafieh-Beirut, Lebanon.
  • Department of Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden.
  • Hypertension and Vascular Risk Unit, Department of Nephrology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.
  • UF Hypertension et Athérothrombose, Centre Européen d'Excellence en Hypertension Artérielle, Service de Cardiologie, Pôle Thorax et Vaisseaux, CHU Michallon, Grenoble, France.
  • Hospital Centre of Vila Nova de Gaia/Espinho, Internal Medicine Department, Hypertension and Cardiometabolic Risk Unit, ESH Excellence Centre, Vila Nova de Gaia, Portugal.
  • Hypertension Unit, Department of Internal Medicine, University Hospital of Heraklion, Heraklion.
  • ESH Excellent Center Hypertension, LAIKO University Hospital, Athens, Greece.
  • Department of Cardiology, Medical University of Graz, Graz, Austria.
  • Faculty of Medicine Oporto, Portugal.

Abstract

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.

MeSH

Kidney Diseases, Hypertension, Pilots, Nephrologists, Renin-Angiotensin System

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