Renal insufficiency: Frequently undetected

In Germany, nearly 2 million people have non-dialysis-dependent renal insufficiency. This is the result presented by Matthias Girndt and colleagues, based on a study from the Robert Koch Institute and published in Deutsches Ärzteblatt International (Dtsch Arztebl Int 2016; 113: 85-91). In a second paper, Falk Hoffmann and colleagues conclude that one in five nursing home residents with renal insufficiency receives a contraindicated medication (Dtsch Arztebl Int 2016; 113: 92-98).

Until now, no population-based estimates for Germany were available about the prevalence of non-dialysis-dependent chronic renal insufficiency. Matthias Girndt and coauthors analyzed data on kidney function from the nationwide "German Health Interview and Examination Survey for Adults," conducted from 2008 to 2011. They found prevalence estimates for Germany of about 1.53 million people with impaired kidney function in the age group 18 to 79 years. In the age group 70 to 79 years, one in eight persons was affected. Only about a quarter of the study population knew of their kidney insufficiency, and of those who were aware of it, only two-thirds received medical treatment for it.

Falk Hoffmann and coauthors examined the supply situation of nursing home residents with renal insufficiency in a cross-sectional study conducted in nursing homes in Bremen and Lower Saxony. They evaluated the medical records of 852 residents from 21 homes. The mean age was 83.3 years, and 75% of the residents were women. Many of these nursing home residents received schedules medication, with about 25% of study participants receiving at least nine. However, a large number of these drugs should be administered at adjusted dosages, or not be given at all, to persons with renal insufficiency. Indeed, Hoffmann and colleagues found that one in five nursing home residents received at least one drug that, according to the summary of product characteristics, was not adequately dosed or even contraindicated for the patient's present kidney function.

In an introductory editorial (Dtsch Arztebl Int 2016; 113: 83-4), Kai-Uwe Eckardt states that since it is rarely possible to improve kidney function therapeutically, the focus is on maintaining existing kidney function. To achieve this, blood pressure and metabolism must be adequately controlled.