LAUSR

Introduction: It is estimated that for every patient in a dialysis or transplant program there are, in the general population, 100 patients with less severe chronic kidney disease (CKD) who will probably develop advanced CKD. These patients have an increased morbidity and mortality due to cardiovascular events and, in the most severe cases, a more rapid progression to renal replacement therapy. Screening, support treatment, prevention of complications and renal replacement therapy are strongly influenced by socioeconomic factors and health system organization resulting in inequalities even within the same territory. This situation may have worsened during the COVID‑19 pandemic due to the health emergency and the isolation experienced by people with severe chronic diseases. The General Pueyrredón District has 656,456 inhabitants and it is the 3rd most populated city in Buenos Aires. Approximately 45% of the population is treated in the public health sector. Objectives To describe the clinical-epidemiological characteristics of patients with pathological abnormalities in renal function tests and to identify the main difficulties in the access to diagnosis, follow-up and treatment at first level of care in the public sector from January to June 2021. Methods: The study was conducted in two phases. First, a cross-sectional study of patients with at least one measurement of plasma creatinine greater than 1.3 mg/dL and 1.5 mg/dL in women and men respectively, urine albumin‑to-creatinine ratio (ACR) greater than 30 mg/g and 24-h proteinuria greater than 300 mg. Second, a situational analysis of the municipal health system to identify the main obstacles to provide care to patients with KD. Results: A total of 306 patients with KD were identified in four months, 54.1% were women. The median age was 52 (IR 44-58) and 55 years old (IR 46.4-62) for women and men respectively. Most abnormalities were seen in ACR values, even in 58.5% of cases it was the only pathological value. Glycosylated hemoglobin (HbA1c) values greater than 7% were found in 17.7% of patients with KD. Peritoneal dialysis was used as replacement therapy only in 3% of the cases. Analyzing the difficulties within the health system, deficient articulation between 1st and 2nd levels, lack of consensus in clinical practice, delay in scheduling appointments resulting in a high demand, obstacles regarding patient care, insufficient follow-up of serious patients and delay in the delivery of laboratory results were observed. Conclusions: In this first study, it was observed that 50% of patients were 45‑60 years old and ACR might have been the most sensitive parameter to detect KD. There was a low prevalence of patients with pathological HbA1c values which may indicate an underdiagnose of KD in diabetic patients. An underutilization of peritoneal dialysis was also observed. From an analysis based on a strategic situational planning, it is proposed to adopt different approaches through the design and implementation of a Renal Care Program based on the integrated risk model suggested by KDIGO aimed at organizing the dispersed clinical practice, improving the efficiency of the system, promoting prevention practices and integrating the public sector with the university and private health institutions. No conflict of interest