Evidence mapPaperPMID 42553456Full record

ArticleFrontiers in medicine2026

Comparison of risks and costs of undiagnosed and diagnosed chronic kidney disease patients after the initiation of kidney replacement therapy in subsequent years. A Hungarian nationwide study.

Levente Kovács, Zsolt Abonyi-Tóth, György Rokszin, Erzsébet Ladányi, Zsolt Fábián, Imre Boncz, István Wittmann, Boglárka Laczy

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Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

8 authors.

Levente KovácsSecond Department of Medicine and Nephrology-Diabetes Center, Medical School, University of Pécs, Pécs, Hungary.
Zsolt Abonyi-TóthDepartment of Biostatistics, University of Veterinary Medicine, Budapest, Hungary.
György RokszinRxTarget Ltd, Szolnok, Hungary.
Erzsébet LadányiNational Dialysis Center, Miskolc Nephrology Center, Miskolc, Hungary.
Zsolt FábiánBoehringer Ingelheim, Budapest, Hungary.
Imre BonczInstitute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pécs, Hungary.
István WittmannSecond Department of Medicine and Nephrology-Diabetes Center, Medical School, University of Pécs, Pécs, Hungary.
Boglárka LaczySecond Department of Medicine and Nephrology-Diabetes Center, Medical School, University of Pécs, Pécs, Hungary.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Introduction: Despite high prevalence, chronic kidney disease (CKD) often remains undiagnosed and untreated, leading to an increased risk of end-stage kidney disease (ESKD), kidney replacement therapy (KRT), comorbidities, and premature death. In this retrospective nationwide study, we examined whether a lack of CKD diagnosis is associated with adverse post-KRT outcomes among newly dialyzed patients with chronic ESKD in Hungary. Methods: Two cohorts-undiagnosed (CKD naive) and diagnosed (CKD non-naive) patients (aged > 18 years)-were compared. Cohorts were defined based on pre-dialysis (>2 months) diagnosis-coding and erythropoietin therapy. We compared the risk of primary endpoints after KRT initiation (including all-cause mortality, acute myocardial infarction, stroke, hospitalization for heart failure (HHF), lower limb amputation (LLA), cancer, kidney transplantation) using propensity score subclassification for 56 confounders (matched data). We also examined exploratory endpoints (total healthcare costs, key comorbidities, laboratory testing, medications) over 5 years pre-KRT and/or post-KRT (unmatched data). Data were collected from the National Health Insurance Fund registry. Results: We identified 38,013 ESKD patients on KRT in 2009-2023, of whom 10,810 started dialysis in 2014-2018. Among these, 33% were undiagnosed (CKD naive). This group experienced more adverse events as early as 3 months post-KRT, including higher deaths (27% vs. 7.8%), HHF (18.8% vs. 11.1%), and cancers (11.2% vs. 2.1%). They also had fewer kidney transplantations (4.6% vs. 14%) at 72 months than the CKD non-naive group. Median survival was markedly shorter for CKD naive patients (3 months) than for CKD non-naive patients (34 months). Cox regression revealed higher risks for CKD naive patients for all-cause mortality [HR: 3.66 (CI: 3.12-4.29), Discussion: Undiagnosed CKD patients experience significantly worse outcomes post-KRT and incur higher long-term costs related to inpatient care. These findings underscore the need for early CKD diagnosis and timely interventions to improve survival and optimize healthcare resource utilization.

Indexed as

chronic kidney disease (CKD)costend-stage kidney disease (ESKD)kidney replacement therapy (KRT)mortalitynationwidereal-world dataundiagnosed

Identifiers

PMID42553456
PMCPMC13434849

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.