Diagnosis of Chronic Kidney Disease in Adults in Portugal: Practical Recommendations from National Clinical and Laboratory Experts

Abstract

Chronic kidney disease represents a significant public health issue, affecting approximately 9.8% of the adult population in Portugal. Despite this figure, early diagnosis of this disease in high-risk groups remains limited. Although only two parameters are essential for its diagnosis – estimated glomerular filtration rate (eGFR) and albuminuria – in Portugal, over 50% of stage 3 - 5 patients have not undergone simultaneous assessment of eGFR and albuminuria. The insufficient implementation of the simultaneous assessment of these two metrics results in an inadequate evaluation of high-risk populations. A task force of 17 Portuguese experts from the main medical specialties involved in chronic kidney disease management (Nephrology and Family Medicine) and in Clinical Pathology/Laboratory Medicine (representatives of major national laboratories) convened to develop guidelines aimed at standardizing procedures for the prescribing, determination, reporting, and interpretation of diagnostic parameters (albuminuria and eGFR based on serum creatinine) in Portugal. This effort is based on clinical practice, scientific knowledge, and international recommendations. This national consensus among the key stakeholders in the chronic kidney disease screening and diagnosis process culminated in the development of four practical guidelines. These guidelines will enable the consistent provision of eGFR and albuminuria measurements, regardless of the attending physician’s medical specialty, the laboratory, or geographic location. Additionally, through this collective effort, experts want to raise awareness among national authorities to the need of developing new guidelines, based on scientific evidence and clinical practice, to address the underassessment of albuminuria and eGFR in this disease’s management.