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Characterizing pre-dialysis care in the era of eGFR reporting: a cohort study

BACKGROUND: Chronic kidney disease (CKD) is a common disorder associated with increased morbidity and mortality. Primary care physicians (PCPs) care for the majority of pre-dialysis CKD patients; however, PCPs often do not recognize the presence of CKD based on serum creatinine levels. Prior studies...

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Autores principales: Abdel-Kader, Khaled, Fischer, Gary S, Johnston, James R, Gu, Chen, Moore, Charity G, Unruh, Mark L
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065401/
https://www.ncbi.nlm.nih.gov/pubmed/21406096
http://dx.doi.org/10.1186/1471-2369-12-12
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author Abdel-Kader, Khaled
Fischer, Gary S
Johnston, James R
Gu, Chen
Moore, Charity G
Unruh, Mark L
author_facet Abdel-Kader, Khaled
Fischer, Gary S
Johnston, James R
Gu, Chen
Moore, Charity G
Unruh, Mark L
author_sort Abdel-Kader, Khaled
collection PubMed
description BACKGROUND: Chronic kidney disease (CKD) is a common disorder associated with increased morbidity and mortality. Primary care physicians (PCPs) care for the majority of pre-dialysis CKD patients; however, PCPs often do not recognize the presence of CKD based on serum creatinine levels. Prior studies suggest that PCPs and nephrologists deliver suboptimal CKD care. One strategy to improve disease awareness and treatment is estimated glomerular filtration rate (eGFR) reporting. We examined PCP and nephrologist CKD practices before and after routine eGFR reporting. METHODS: We conducted a retrospective cohort study of patients with CKD 3b-4 (eGFR < 45) seen at a university-based, outpatient primary care clinic. Using a chi-square or Fisher's exact test, we compared co-management rates, renal protective strategies, CKD documentation, and laboratory processes of care in 274 patients and 266 patients seen in a 6-month period prior to and following eGFR implementation, respectively. RESULTS: CKD co-management increased from 22.6% pre-eGFR to 48.5% post-eGFR (P < 0.0001). eGFR reporting did not improve angiotensin converting enzyme inhibitor or angiotensin receptor blocker use or quantitative urinary testing. However, non-steroidal anti-inflammatory drug avoidance (pre-eGFR 81.8% vs. post- eGFR 90.6%, P = 0.003) and phosphorus and parathyroid hormone testing improved (pre-eGFR vs. post-eGFR: 32.5% vs. 51.5%, P < 0.0001; 12.4% vs. 36.1%, P < 0.0001 respectively). CONCLUSIONS: A marked increase in CKD co-management was observed following eGFR implementation. Although some improvements in processes of care were noted, this did not include angiotensin converting enzyme inhibitor or angiotensin receptor blocker use. Overall care remained suboptimal despite eGFR reporting; further strategies are needed to improve PCP and nephrologist CKD care.
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spelling pubmed-30654012011-03-29 Characterizing pre-dialysis care in the era of eGFR reporting: a cohort study Abdel-Kader, Khaled Fischer, Gary S Johnston, James R Gu, Chen Moore, Charity G Unruh, Mark L BMC Nephrol Research Article BACKGROUND: Chronic kidney disease (CKD) is a common disorder associated with increased morbidity and mortality. Primary care physicians (PCPs) care for the majority of pre-dialysis CKD patients; however, PCPs often do not recognize the presence of CKD based on serum creatinine levels. Prior studies suggest that PCPs and nephrologists deliver suboptimal CKD care. One strategy to improve disease awareness and treatment is estimated glomerular filtration rate (eGFR) reporting. We examined PCP and nephrologist CKD practices before and after routine eGFR reporting. METHODS: We conducted a retrospective cohort study of patients with CKD 3b-4 (eGFR < 45) seen at a university-based, outpatient primary care clinic. Using a chi-square or Fisher's exact test, we compared co-management rates, renal protective strategies, CKD documentation, and laboratory processes of care in 274 patients and 266 patients seen in a 6-month period prior to and following eGFR implementation, respectively. RESULTS: CKD co-management increased from 22.6% pre-eGFR to 48.5% post-eGFR (P < 0.0001). eGFR reporting did not improve angiotensin converting enzyme inhibitor or angiotensin receptor blocker use or quantitative urinary testing. However, non-steroidal anti-inflammatory drug avoidance (pre-eGFR 81.8% vs. post- eGFR 90.6%, P = 0.003) and phosphorus and parathyroid hormone testing improved (pre-eGFR vs. post-eGFR: 32.5% vs. 51.5%, P < 0.0001; 12.4% vs. 36.1%, P < 0.0001 respectively). CONCLUSIONS: A marked increase in CKD co-management was observed following eGFR implementation. Although some improvements in processes of care were noted, this did not include angiotensin converting enzyme inhibitor or angiotensin receptor blocker use. Overall care remained suboptimal despite eGFR reporting; further strategies are needed to improve PCP and nephrologist CKD care. BioMed Central 2011-03-15 /pmc/articles/PMC3065401/ /pubmed/21406096 http://dx.doi.org/10.1186/1471-2369-12-12 Text en Copyright ©2011 Abdel-Kader et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Abdel-Kader, Khaled
Fischer, Gary S
Johnston, James R
Gu, Chen
Moore, Charity G
Unruh, Mark L
Characterizing pre-dialysis care in the era of eGFR reporting: a cohort study
title Characterizing pre-dialysis care in the era of eGFR reporting: a cohort study
title_full Characterizing pre-dialysis care in the era of eGFR reporting: a cohort study
title_fullStr Characterizing pre-dialysis care in the era of eGFR reporting: a cohort study
title_full_unstemmed Characterizing pre-dialysis care in the era of eGFR reporting: a cohort study
title_short Characterizing pre-dialysis care in the era of eGFR reporting: a cohort study
title_sort characterizing pre-dialysis care in the era of egfr reporting: a cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065401/
https://www.ncbi.nlm.nih.gov/pubmed/21406096
http://dx.doi.org/10.1186/1471-2369-12-12
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