Management of chronic kidney disease in an academic primary care clinic

Abstract

Background: Three million people in the United States are estimated to have chronic kidney disease (CKD). Management of these CKD patients in the outpatient primary care clinic setting has not been well studied.

Hypothesis: Primary care management of CKD can be assessed and opportunities for improvement can be identified.

Methods: Management of CKD based on available published literature and guidelines was assessed in a single primary care site of an academic hospital with 23,000 annual visits and 8,300 patients. Charts of patients seen between October 1, 1997 and March 25, 1999 with an elevated SCr > or = 1.7 mg/dl on two separate measurements at least 6 months apart were reviewed for predefined indicators of CKD management.

Results: Assessment identified several aspects of CKD management to be suboptimal: control of blood pressure, use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, assessment of proteinuria, and renal consultation. Better management was found with respect to hemoglobin A1c measurement for diabetic patients. In general, CKD care was similar for diabetic and non-diabetic patients. CKD management was also similar regardless of level of creatinine clearance (> or = 50 vs. 50-30 vs. < or = 30 ml/min).

Conclusion: CKD care can be measured in an outpatient academic primary care clinic and opportunities to improve were identified.