Barriers to successful care for chronic kidney disease

BMC Nephrol. 2005 Oct 27;6:11. doi: 10.1186/1471-2369-6-11.


Background: The National Kidney Foundation has formulated clinical practice guidelines for patients with chronic kidney disease (K/DOQI). However, little is know about how many patients actually achieve these goals in a dedicated clinic for chronic kidney disease.

Methods: We performed a cross-sectional analysis of 198 patients with an estimated glomerular filtration rate of less than 30 ml/min/1.73 m2 and determined whether K/DOQI goals were met for calcium, phosphate, calcium-phosphate product, parathyroid hormone, albumin, bicarbonate, hemoglobin, lipids, and blood pressure.

Results: We found that only a small number of patients achieved K/DOQI targets. Recent referral to the nephrologist, failure to attend scheduled clinic appointments, African American ethnicity, diabetes, and advanced renal failure were significant predictors of low achievement of K/DOQI goals.

Conclusion: We conclude that raising awareness of chronic kidney disease and K/DOQI goals among primary care providers, early referral to a nephrologist, the exploration of socioeconomic barriers and cultural differences, and both patient and physician education are critical to improve CKD care in patients with Stage 4 and 5 CKD.

MeSH terms

  • African Americans
  • Chronic Disease
  • Cross-Sectional Studies
  • Diabetes Complications
  • Glomerular Filtration Rate
  • Goals
  • Guideline Adherence
  • Humans
  • Kidney Diseases / ethnology
  • Kidney Diseases / etiology
  • Kidney Diseases / physiopathology
  • Kidney Diseases / therapy*
  • Kidney Failure, Chronic / therapy
  • Nephrology
  • Office Visits
  • Patient Compliance
  • Practice Guidelines as Topic*
  • Primary Health Care
  • Referral and Consultation