Treatment Patterns, Disease Management, and Quality of Life in Outpatients with CKD and Decreased eGFR: A Multicenter Prospective Observational Study in Greece

Abstract

Background/Objectives: Chronic kidney disease (CKD) is a major cause of morbidity and mortality. Evidence on routine management and patient-reported outcomes in Greece is limited. The SPIRIT study assessed real-world treatment patterns, disease management, and quality of life (QoL) among CKD patients in Greece. Methods: This was a prospective, multicenter, observational study in Outpatient Nephrology Clinics of fifteen National Health System (NHS) Hospitals in Greece enrolling adults with estimated glomerular filtration rate (eGFR) calculated using the chronic kidney disease epidemiology collaboration (CKD-EPI) equation (CKD-EPI eGFR) between 15 and <60 mL/min/1.73 m2, with a 12-month follow-up. Results: A total of 305 CKD patients participated in the study (40.0% classified as stage G3a, 39.0% G3b, and 21.0% G4), with a mean age of 69.3 years. Antihypertensives were administered to 84.3%, 84.1%, and 85.1% of patients at baseline, 6, and 12 months, respectively, mostly calcium channel blockers, while lipid-lowering agents were administered to 63.3%, 64%, and 63.2% at baseline, 6, and 12 months, respectively, predominantly statins (95.3%, 95.9%, and 96.5% of lipid-lowering users). Interestingly, renin-angiotensin-aldosterone system (RAAS) inhibitors were administered to a total of 160 patients, 91.9% of whom had hypertension, while sodium-glucose cotransporter 2 (SGLT2) inhibitors were administered to 45 patients, with 66.7% of them suffering from CKD and type 2 diabetes. SGLT2i use increased from 15.3% at baseline to 35.4% at 12 months. Mean CKD-EPI eGFR remained stable (mean 40.1, 41.3, and 40.7 mL/min/1.73 m2), while median urine albumin-to-creatinine ratio (UACR) increased from 145.2 mg/g at baseline to 253.4 mg/g at 6 months and 246.6 mg/g at 12 months. Statistically significant improvements (p < 0.05) were observed between 6 and 12 months in specific domains of the Kidney Disease QoL-Short Form (KDQOL-SF) v1.3. Conclusions: The study provides real-world evidence on stage-related treatment patterns, routine management, and QoL in CKD outpatients in Greece.