Abstract
BackgroundChronic 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.MethodsWe 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.ResultsCKD 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).ConclusionsA 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.
Highlights
Chronic kidney disease (CKD) is a common disorder associated with increased morbidity and mortality
While CKD care delivery to both Primary care physicians (PCPs) managed and co-managed patients remained suboptimal after estimated glomerular filtration rate (eGFR) reporting, comanaged patients were less likely to be on non-steroidal anti-inflammatory drug (NSAID) and more likely to have lab testing for complications of CKD
Following the implementation of routine eGFR reporting at an academic, outpatient primary care clinic, there has been a marked increase in the co-management of CKD 3b-4 patients and modest to moderate improvement in CKD processes of care including NSAID avoidance and mineral and bone disease related lab testing
Summary
Chronic kidney disease (CKD) is a common disorder associated with increased morbidity and mortality. We examined PCP and nephrologist CKD practices before and after routine eGFR reporting. The routine reporting of eGFR values with serum creatinine has been advocated by some experts as an important approach to improve CKD awareness and treatment [22,23,24] and recent data reveal that an increasing number of US labs are adopting universal eGFR reporting [21,25]. Multiple studies have documented the effect of routine eGFR reporting on renal referrals [8,26,27,28]; few studies have examined the quality of care delivered to CKD patients since the implementation of eGFR reporting [28,29,30]. Despite previously well-documented deficiencies in nephrologist care of CKD patients [10,31,32,33,34,35], few studies have examined whether there have been improvements in the care of co-managed CKD patients following eGFR reporting
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