Abstract
BackgroundEarly detection of chronic kidney disease (CKD) is sub-optimal among the general population and among high risk patients. The prevalence and impact of major CKD risk factors, diabetes (DM) and hypertension (HTN), on CKD documentation among managed care populations have not been previously reported. We examined this issue in a Kaiser Permanente Georgia (KPG) CKD cohort.MethodsKPG enrollees were included in the CKD cohort if they had eGFRs between 60 and 365 days apart that were <90 ml/min during 1999-2006. The current analysis is restricted to participants with eGFR 10-59 ml/min/1.73 m2. CKD documentation was defined as a presenting diagnosis of CKD by a primary care physician or nephrologist using ICD-9 event codes. The association between CKD documentation and DM and HTN were assessed with multivariate logistic regression models.ResultsOf the 50,438 subjects within the overall KPG CKD cohort, 20% (N = 10,266) were eligible for inclusion in the current analysis. Overall, CKD diagnosis documentation was low; only 14.4% of subjects had an event-based CKD diagnosis at baseline. Gender and types 2 diabetes interacted on CKD documentation. The prevalence of CKD documentation increased with the presence of hypertension and/or type 2 diabetes, but type 2 diabetes had a lower effect on CKD documentation. In multivariate analysis, significant predictors of CKD documentation were eGFR, hypertension, type 2 diabetes, congestive heart failure, peripheral artery disease, statin use, age and gender. CKD documentation was lower among women than similarly affected men.ConclusionAmong patients with an eGFR 10-59, documentation of CKD diagnosis by primary and subspecialty providers is low within a managed care patient cohort. Gender disparities in CKD documentation observed in the general population were also present among KPG CKD enrollees.
Highlights
Detection of chronic kidney disease (CKD) is sub-optimal among the general population and among high risk patients
At the time of enrollment hypertension was present for 77%, 24% had diabetes, 13% had coronary artery disease, 7% had congestive heart failure, 5% had peripheral artery disease and 2% had cerebrovascular disease
*Significant interactions in multivariate model were found between type 2 diabetes and gender with respect to CKD documentation (p value for interaction = 0.0053), as well as between type 2 diabetes and hypertension (p value for interaction = 0.0065) with respect to CKD documentation. **estimated glomerular filtration rate (eGFR) in ml/min/1.73 m2 aware of their CKD status, and our results extend these findings by reporting that providers are less likely to recognize CKD among women with a reduced GFR compared with men [8,11,17]
Summary
Detection of chronic kidney disease (CKD) is sub-optimal among the general population and among high risk patients. The prevalence and impact of major CKD risk factors, diabetes (DM) and hypertension (HTN), on CKD documentation among managed care populations have not been previously reported. The National Kidney Foundation's Kidney Disease Outcome Quality Initiative (KDOQI) evidence-based clinical practice guidelines for CKD recommend periodic screening of high risk individuals for CKD [10]. Serum creatinine, protein-to-creatinine ratio, imaging of the kidneys) Despite these recommendations, there is evidence from national population surveys that high risk patients are often not screened for CKD and that the presence of CKD may go unidentified [8,11]. CKD identification by health care providers within health maintenance organizations have not been fully examined, and predictors of provider awareness of CKD in a high risk patient population have not been reported
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