Recognition and management of chronic kidney disease in an elderly ambulatory population

J Gen Intern Med. 2008 Aug;23(8):1125-30. doi: 10.1007/s11606-008-0607-z. Epub 2008 Apr 29.

Abstract

Background: Chronic kidney disease (CKD) is a growing problem among the elderly. Early detection is considered essential to ensure proper treatment and to avoid drug toxicity, but detection is challenging because elderly patients with CKD often have normal serum creatinine levels. We hypothesized that most cases of CKD in the elderly would go undetected, resulting in inappropriate prescribing.

Objective: To determine whether recognition of CKD is associated with more appropriate treatment

Design: Retrospective chart review

Participants: All patients aged >/=65 years with a measured serum creatinine in the past 3 years at 2 inner city academic health centers.

Measurements: Estimated glomerular filtration rate (eGFR) calculated using the Modified Diet in Renal Disease equation, and for patients with eGFR < 60, documentation of CKD by the provider, diagnostic testing, nephrology referral and prescription of appropriate or contraindicated medications.

Results: Of 814 patients with sufficient information to estimate eGFR, 192 (33%) had moderate (eGFR < 60 mL/min) and 5% had severe (eGFR < 30 mL/min) CKD. Providers identified 38% of moderate and 87% of severe CKD. Compared to patients without recognized CKD, recognized patients were more likely to receive an ACE/ARB (80% vs 61%, p = .001), a nephrology referral (58% vs 2%, p < .0001), or urine testing (75% vs 47%, p < .0001), and less likely to receive contraindicated medications (26% vs 40%, p = .013).

Conclusions: Physicians frequently fail to diagnose CKD in the elderly, leading to inappropriate treatment. Efforts should focus on helping physicians better identify patients with low GFR.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers
  • Aged
  • Aged, 80 and over
  • Angiotensin II Type 1 Receptor Blockers / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Clinical Laboratory Techniques
  • Creatinine / blood
  • Diagnostic Imaging
  • Early Diagnosis
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Kidney Failure, Chronic / diagnosis*
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / therapy*
  • Logistic Models
  • Male
  • Massachusetts / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Urban Population

Substances

  • Angiotensin II Type 1 Receptor Blockers
  • Angiotensin-Converting Enzyme Inhibitors
  • Creatinine