What question did this study set out to answer?

The aim is to examine the impact of missed chronic kidney disease (CKD) diagnoses on health outcomes in adults.

January 16, 2026Journal of the American Society of Nephrology0 citations

Clinical Implications of Missed CKD Diagnosis in Adults with and without Diabetes Mellitus

NLNomy Levin-IainaBen-Gurion University of the Negev ARAnat Reiner‐BenaimBen-Gurion University of the Negev SAShaden Abu-AkelBen-Gurion University of the Negev

Key Points

The aim is to examine the impact of missed chronic kidney disease (CKD) diagnoses on health outcomes in adults.
Nationwide cohort study with 640,217 adults meeting CKD criteria.
Defined CKD underdiagnosis as lack of documented diagnosis in medical records.
Primary endpoint assessed was time to all-cause mortality or kidney replacement therapy.
Used Cox proportional hazards models and propensity score-matched analyses.
56% of patients with CKD had no recorded diagnosis.
Undiagnosed individuals experienced higher first-year mortality (8% vs 4.1%).
Undiagnosed patients had a higher risk of death or kidney replacement therapy (hazard ratio 1.10).
Significantly lower use of reno and cardioprotective medications in undiagnosed patients.
SGLT2 inhibitors showed protective benefits in both diabetic and non-diabetic groups.

Abstract

Background: Chronic kidney disease (CKD) is a global public health challenge, yet underdiagnosis in routine care remains pervasive, leading to missed opportunities for early intervention. Evidence directly linking missed diagnosis to adverse outcomes in large, nationwide populations is limited. Methods: We conducted a nationwide, population-based cohort study including 640,217 adults meeting KDIGO laboratory criteria for CKD (eGFR 30 mg/g on at least two occasions ≥ 3 months apart) between 2000–2023. CKD underdiagnosis was defined as absence of a documented diagnosis in electronic medical records. The primary endpoint was a composite of all-cause mortality or kidney replacement therapy (KRT). Secondary endpoints included first-year mortality and time to all-cause mortality, KRT, and major cardiovascular events. Associations were assessed using multivariable Cox proportional hazards models, stratified by diabetes status, with additional propensity score-matched sensitivity analyses. Results: Of 640,217 patients who met laboratory criteria for CKD, 359,805 (56%) lacked a documented diagnosis. Undiagnosed patients were younger, more often female, and disproportionately from minoritized populations. Absence of a CKD diagnosis was associated with a markedly shorter time to death or KRT (hazard ratio 1.10; 95% CI, 1.09-1.11). First-year mortality was higher in undiagnosed versus diagnosed CKD (8.0% 95% CI, 7.9-8.1 vs. 4.1% 95% CI, 4.0-4.2), despite less advanced disease at baseline. Use of reno and cardioprotective medications was significantly lower in undiagnosed patients. SGLT2 inhibitor therapy was independently associated with lower risks of death, kidney failure, and cardiovascular events, showing a consistent protective effect in both diabetic and non-diabetic subgroups. Findings were consistent across sensitivity analyses. Conclusions: In this real-world nationwide CKD cohort, underdiagnosis was common and associated with premature death, kidney failure, and cardiovascular morbidity. There was consistent association of SGLT2 inhibitors with better cardiovascular and kidney health outcomes.

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