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

Abdel-Kader, K and Fischer, GS and Johnston, JR and Gu, C and Moore, CG and Unruh, ML (2011) Characterizing pre-dialysis care in the era of eGFR reporting: A cohort study. BMC Nephrology, 12 (1).

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Abstract

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. © 2011 Abdel-Kader et al; licensee BioMed Central Ltd.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Abdel-Kader, Kkaa43@pitt.eduKAA43
Fischer, GSgaf1@pitt.eduGAF1
Johnston, JRjamiej@pitt.eduJAMIEJ
Gu, C
Moore, CG
Unruh, ML
Date: 17 March 2011
Date Type: Publication
Journal or Publication Title: BMC Nephrology
Volume: 12
Number: 1
DOI or Unique Handle: 10.1186/1471-2369-12-12
Schools and Programs: School of Medicine > Medicine
Refereed: Yes
Date Deposited: 31 Oct 2016 16:03
Last Modified: 02 Feb 2019 18:55
URI: http://d-scholarship.pitt.edu/id/eprint/30085

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