Cor Vasa 2025, 67(6):687-696

(Application of KDIGO guidelines for CKD diagnosis in clinical practice: cross-sectional study of eGFR and ACR testing in the Czech Republic)

Ivo Hlaváč^a, Miloš Táborský^b, Matěj Opatrný^c

¹ Ústav epidemiologie a ochrany veřejného zdraví, Lékařská fakulta, Ostravská univerzita, Ostrava, Česká republika

² Kardiologická klinika, Masarykova nemocnice, o.z., Krajská zdravotní, a.s., Ústí nad Labem, Česká republika

³ Institut ekonomických studií, Univerzita Karlova, Praha, Česká republika

Background: Chronic kidney disease (CKD) affects 9-13% of the global population. KDIGO guidelines recommend simultaneous albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) testing for proper CKD staging. Data on compliance with these standards in Czech practice are lacking.

Methods: Cross-sectional retrospective analysis of 62,567 patients examined between January 2022 and April 2025 in Unilabs laboratories. We assessed availability of eGFR and ACR testing across specialties and compliance with KDIGO recommendations.

Results: Median age 67.0 years (IQR 54.3-75.4), 54% male. ACR was tested in 97.2% of patients, eGFR in only 3.3%. Complete eGFR + ACR testing for CKD staging was performed in only 0.5% of patients (n = 289). Nephrology showed the highest compliance (91% of all complete tests), general practitioners only 2.1%. CKD prevalence (eGFR <60 ml="" min="" 1="" 73="" m="" sup="">2 or ACR ≥3 mg/mmol) was 25.6%; after excluding nephrology examinations, it decreased to 21.5%. We demonstrated eGFR decline of 1.397 ml/min/1.73 m²/year of age (95% CI: -1.514 to -1.279; p <0.0001).

Conclusion: Compliance with KDIGO guidelines is critically low - only 0.5% of patients have complete testing. The main deficit is minimal eGFR utilization (3.3%), which laboratories do not routinely report. Implementation of automatic eGFR calculation, standardization of laboratory requests, and physician education are essential for improving early CKD diagnosis.

Keywords: Chronic kidney disease, eGFR, KDIGO, Screening, uACR

Received: October 4, 2025; Revised: October 12, 2025; Accepted: November 6, 2025; Prepublished online: June 2, 2012; Published: December 15, 2025  Show citation