Abstract Background Chronic kidney disease (CKD) represents one of the most significant risk factors for cardiovascular disease (CVD), major adverse cardiovascular events (MACE), and CVD-related mortality. However, thereremains a gap between real-world clinical practice and guideline recommendations regarding CKD in the CVD population. Purpose We aimed to assess the diagnosis, treatment pattern of CKD in CVD patients. Methods We conducted a nationwide multi-center cross-sectional study involving 25 centers across China from July 2023 to June 2024. The study enrolled cardiovascular disease patients meeting CKD diagnostic criteria, defined as two qualifying measurements (separated by 90-730 days) of either:(1) estimated glomerular filtration rate (eGFR) 20-60 mL/min/1.73 m²,or(2) urinary albumin-to-creatinine ratio (uACR) ≥30 mg/g creatinine,with documented cardiology hospitalization within the preceding year. The primary endpoint was CKD diagnosis rate, while secondary endpoint was CKD treatment patterns. Multivariable logistic regression analysis was employed to identify risk factors associated with diagnosis and treatment. Results The study enrolled 2,156 patients (mean age 73.1±10.8 years; 65.0% male). 1,645 patients (76.9%) were undiagnosed (lacked a CKD diagnostic code). Multivariable analysis revealed younger age (75 years: aOR=1.32, p=0.032) and moderate CKD stage (stage 3: aOR=2.09, p0.001) as independent risk factors for undiagnosed CKD. Only 711 patients (33.0%) received KDIGO guideline-recommended treatment for CKD. It demonstrated that advanced CKD (aOR=2.11, p0.001), absence of coronary artery disease (aOR=2.59, p0.001), absence of congestive heart failure (aOR=1.48, p=0.002), higher left ventricular ejection fraction (per 1% increase: aOR=1.01, p=0.011), and older age (per year: aOR=1.02, p0.001) were independently associated with lack of guideline-directed treatment. Conclusion Chronic kidney disease remains under-diagnosed in cardiovascular disease patients, particularly among younger adults and those with early-stage CKD. Furthermore, a critical lack of awareness and treatment persists in patients without coronary artery disease or heart failure, demanding urgent prioritization in clinical practice.Graphical Abstract
Ling et al. (Sat,) studied this question.