Unveiling the Current Landscape of CKD Diagnosis and Treatment in China: A National Multicenter Analysis

Background: This study aims to delineate the epidemiological features and treatment landscape of chronic kidney disease (CKD) patients in China to inform and optimize clinical practice by using a nationwide, high-quality, disease-specific CKD database. Methods: We analyzed data from adult CKD patients in the China Renal Data System database. Patients were stratified by: ●CKD stage (including stage 5 subgroups: dialysis, transplant, and non-dialysis) ●Nephrology consultation status ●Periods of treatment: 2010-2014, 2015-2019, and 2020-2023. Key outcomes included: ●Clinical characteristics ●Medication utilization patterns ●Missed diagnosis rates Results: This nationwide analysis of 832,641 CKD patients in China revealed a high burden of advanced disease: 23.2% of the cohort had stage 5 CKD. Median age 59.5 years (IQR 45.8-72.1) with eGFR 58.5 mL/min/1.73m2 (IQR 30.2-91.3); 39% had severe proteinuria (A3). Comorbidities were common (hypertension: 68.7%; dyslipidemia: 61.2%) and worsened with CKD progression. Treatment gaps were evident: only 29.9% of patients received guideline-recommended RAAS inhibitors, peaking at 37.1% in stage 3. Nephrology-managed patients received more comprehensive care （Figure 1). The overall missed diagnosis rate has shown improvement over time, decreasing from 45.1% during the period of 2010-2014 to 35.4% in 2020-2023. However, missed diagnosis rates in early-stage CKD (1-3) remain alarmingly high (over 40%). Nephrology care reduced missed diagnoses to 10% (Figure 2). Conclusion: This study reveals significant delays and inadequacies in the diagnosis and treatment of CKD in China, with an urgent need to enhance early screening, promote guidelines, and foster multidisciplinary collaboration.