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The BIGERD project was co-founded by a competitive unrestricted grant from Madrid Nephrology Foundation (2019-2020) and Public Research Network REDinREN RETIC ISCIII 16/009/009 and Research Institute Puerta de Hierro-Segovia Arana. This study has not been funded by SAVANA. Neither the funders or our institution had any role in the study design; collection, analysis and interpretation of data; writing the report or the decision to submit the report for publication. Neither the sponsor or our institution imposed any limits on the authors' access to all the study's data.

Analysis of institutional authors

Ortiz, AAuthorPortoles, JAuthor

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June 15, 2022
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The hidden diabetic kidney disease in a university hospital-based population: a real-world data analysis

Publicated to:Clinical Kidney Journal. 15 (10): 1865-1871 - 2022-04-14 15(10), DOI: 10.1093/ckj/sfac100

Authors: Marques, Maria; Lopez-Sanchez, Paula; Tornero, Fernando; Gargantilla, Pedro; Maroto, Alba; Ortiz, Alberto; Portoles, Jose;

Affiliations

Fdn Jimenez Diaz, Nephrol Dept, Madrid, Spain - Author
Hosp El Escorial, Internal Med Dept, Madrid, Spain - Author
Hosp Univ Puerta Hierro, IDIPHISA, Nephrol Dept, Madrid, Spain - Author
Hosp Univ Sureste, Nephrol Dept, Madrid, Spain - Author
Inst Salud Carlos III, Res Network REDInREN 016 009 009, Madrid, Spain - Author
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Abstract

Background Correct identification of diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM) patients is crucial to implement therapeutic interventions that may prevent disease progression. Methods We compared the real prevalence of DKD in T2DM patients according to actual serum and urine laboratory data with the presence of the diagnostic terms DKD and/or CKD on the electronic medical records (EMRs) using a natural language processing tool (SAVANA Manager). All patients >18 years of age and diagnosed with T2DM were selected. DKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) or a urinary albumin:creatinine ratio (UACR) >30 mg/g or a urinary protein:creatinine ratio (UPCR) >0.3 g/g after excluding acute kidney injury. Results A total of 15 304 T2DM patients identified on EMRs were eligible to enter the study. A total of 4526 (29.6%) T2DM patients had DKD according to lab criteria. However, the terms CKD or DKD were only present in 33.1% and 7.5%, representing a hidden prevalence of CKD and DKD of 66.9% and 92.5%, respectively. Less severe kidney disease (lower UACR or UPCR, higher eGFR values), female sex and lack of insulin prescription were associated with the absence of DKD or CKD terms in the EMRs (P < .001) Conclusions The prevalence of DKD among T2DM patients defined by lab data is significantly higher than that reported on hospital EMRs. This could imply underdiagnosis of DKD, especially in patients with the least severe disease who may benefit the most from optimized therapy.

Keywords

chronic kidney diseasediabetic kidney diseasegenderreal-world dataChronic kidney diseaseDiabetic kidney diseaseGenderMortalityReal-world dataRiskUnderdiagnosis

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Clinical Kidney Journal due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position 17/88, thus managing to position itself as a Q1 (Primer Cuartil), in the category Urology & Nephrology.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 5.58, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-07, the following number of citations:

  • WoS: 2
  • Europe PMC: 1
  • Google Scholar: 4

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-07:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 13.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 24 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 15.15.
  • The number of mentions on the social network Facebook: 1 (Altmetric).
  • The number of mentions on the social network X (formerly Twitter): 28 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.

Leadership analysis of institutional authors

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: Last Author (PORTOLES PEREZ, JOSE MARIA).