Chronic kidney disease in Romania: national adjusted prevalence, risk factors, and temporal trends in high-risk groups

Chronic kidney disease (CKD) is a growing global health concern, associated with substantial morbidity and mortality. In Romania, national-level data on CKD prevalence remain limited. This study aimed to estimate the prevalence and risk factors of CKD in Romania using two independent cohorts: a general population cohort (2007–2008) and a targeted high-risk cohort (2023) consisting of individuals with hypertension, diabetes, or cardiovascular disease. The general population cohort (N = 26,831) was derived from a national health survey in Iassy. The 2023 targeted cohort (N = 2,247) was screened using a structured, software-assisted protocol by general practitioners in Bucharest. CKD was defined as eGFR < 60 mL/min/1.73 m² and/or albuminuria ≥ 30 mg/g; the 3-month chronicity criterion was applied only in the 2023 cohort. Risk categories for CKD progression (moderate, high, very high) were assigned according to KDIGO definitions. The standardized national prevalence of CKD was 8.97%. CKD prevalence in the high-risk 2023 cohort was 27%, compared to 18% in a matched at-risk group from the 2007–2008 cohort. Most CKD cases were at moderate risk, though the proportion of very high-risk individuals increased over time (7.6% to 10.5%). Targeted screening doubled detection efficiency (number needed to screen = 4 vs. 7). CKD is a public health issue in Romania, particularly among individuals with cardiometabolic comorbidities. Targeted screening improves detection efficiency and may serve as a cost-effective strategy to reduce disease burden.