Laboratory investigation and follow-up of chronic kidney disease stage 3 in primary care

Abstract

BackgroundTo explore how CKD stage 3 patients are examined and treated in primary care with emphasis on laboratory analyses. MethodsA total of 386 patients with CKD stage 3, and their physician (one patient per general practitioner (GP)) were selected from hospital laboratory databases. GPs received a questionnaire asking them to categorize their patients' renal function based on creatinine and eGFR results, denoting follow-up and what changes in creatinine and eGFR results were considered clinically important. ResultsThe response rate was 60%, and 210 patients were included. Patients' median creatinine values were 95μmol/L (females) and 124μmol/L (males), the median eGFR value was 52ml/min/1.73m2. Only 27% of patients were assessed to have CKD stage 3. 2/3 had either a urine dip strip (59%) and/or a urine albumin measurement (42%) and 20% were diagnosed with albuminuria. Median changes to signal improvement or deterioration in renal function or indicate referral were 14 (12%), 20 (18%) and 40 (36%)μmol/L for creatinine and 8 (17%), 8 (17%) and 13 (26%)ml/min/1.73m2 for eGFR. Albuminuria did not influence follow-up strategy. ConclusionsCKD stage 3 patients were insufficiently examined for albuminuria and seemingly referred to hospital care after larger eGFR declines than recommended in guidelines.