Abstract
BackgroundMost non-dialysis dependent chronic kidney disease (CKD) patients are cared for by their primary care physicians (PCPs). Studies suggest many CKD patients receive suboptimal care. Recently, CKD clinical practice guidelines were updated with additional emphasis on albuminuria.MethodsWe performed an internet-based, cross-sectional survey of active PCPs in the United States using the American Medical Association Physician Masterfile. We explored CKD guideline familiarity, self-reported practice behaviors, and attitudinal and external barriers to implementing guideline recommendations, including albuminuria testing.ResultsOf 12,034 PCPs targeted, 848 opened a study email, 165 (19.5%) responded. Most respondents (88%) spent ≥50% of their time in clinical care. Respondents were generally in private practice (46%). Most PCPs (96%) felt that eGFR values were helpful. Approximately, 75% and 91% of PCPs reported testing for albuminuria in non-diabetic hypertensive patients with an eGFR > 60 ml/min/1.73 m2 and < 60 ml/min/1.73 m2, respectively. Barriers to albuminuria testing included a lack of effect on management, limited time, and the perceived absence of guidelines recommending testing. While PCPs expressed high levels of agreement with the definition of CKD, 30% were concerned with overdiagnosis in older adults with an eGFR in the CKD stage 3a range. Most PCPs felt that angiotensin converting enzyme inhibitor (ACEi)/ angiotensin II receptor blockers (ARBs) improved outcomes in CKD, though agreement was lower with severe vs. moderate albuminuria (78% vs. 85%, respectively, p = 0.03). Many PCPs (51%) reported being unfamiliar with CKD guidelines, but were receptive to systematic interventions to improve their CKD care.ConclusionsPCPs generally agree with CKD clinical practice guidelines regarding CKD definition and albuminuria testing. However, future interventions are necessary to improve PCPs’ familiarity with CKD guidelines, overcome barriers to albuminuria testing and, assist PCPs in targeting ACEi/ARBs to the patients most likely to benefit.
Highlights
Most non-dialysis dependent chronic kidney disease (CKD) patients are cared for by their primary care physicians (PCPs)
In contrast to prior studies where only serum creatinine and proteinuria were used [16,42], we found that PCPs were relatively knowledgeable in identifying CKD based on Estimated glomerular filtration rate (eGFR) and Intervention to improve CKD care
We found that most PCPs felt that non-diabetic patients with an eGFR < 60 ml/min/1.73 m2 would benefit from an angiotensin converting enzyme inhibitor (ACEi)/ Angiotensin receptor blocker (ARB) regardless of proteinuria
Summary
Most non-dialysis dependent chronic kidney disease (CKD) patients are cared for by their primary care physicians (PCPs). These include suboptimal screening/ monitoring of patients with CKD risk factors [4,5], infrequent discussions between providers and patients regarding CKD [6], suboptimal albuminuria testing in CKD patients [7,8], suboptimal blood pressure control [9], and suboptimal renin-angiotensin blockade in CKD patients with proteinuria [10,11] In light of these deficiencies, studies have demonstrated shortcomings in PCP knowledge of CKD risk factors [12,13] and poor awareness of Kidney Disease Outcomes Quality Initiative (KDOQI) clinical practice guidelines [14,15,16,17]. We assessed interventions PCPs would find most acceptable to optimize CKD care
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