LAS VEGAS – Slightly more than half of primary care physicians reported being unfamiliar with 14-year-old guidelines on nondiabetic chronic kidney disease, but 75% said they were willing to improve how they cared for patients with the condition, results from a Web-based survey showed.
Most 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, according to a report published in advance of its presentation by Dr. Khaled Abdel-Kader at a meeting sponsored by the National Kidney Foundation.
Dr. Khaled Abdel-Kader
"Rigorous studies are needed to help identify systematic interventions that can overcome identified barriers and improve optimal CKD care delivery," Dr. Abdel-Kader said in an interview following his presentation. "Based on our findings, while overcoming knowledge deficits and attitudinal barriers remains important, many primary care physicians set appropriate care goals in CKD, but systems are needed to help them and their patients achieve these goals," (BMC Nephrol. 2014 April 22 [doi:10.1186/1471-2369-15-64]).
Dr. Neil Skolnik noted that CKD is an incredibly important topic, affecting more than 15% of the U.S. population. "This is an excellent study with a very good response rate for an e-mail survey, indicating that primary care physicians are interested in the care of patients with CKD.
"This interest is reflected in the answers provided on the survey. With half of primary care physicians unfamiliar with the CKD guidelines, and 75% expressing interest in improving their care of patients with CKD, the next step should focus on how to best disseminate information about the guidelines and provide tools for primary care physicians to best implement the guidelines," said Dr. Skolnik, who is professor of family and community medicine at Temple University, Philadelphia.
Dr. Abdel-Kader and his associates used data from the American Medical Association to conduct a cross-sectional, Web-based survey of PCPs in the United States in an effort to explore their understanding of CKD guidelines, self-reported practice behaviors, and barriers to implementing guideline recommendations, including albuminuria testing. The National Kidney Foundation issued its most recent update to its guidelines in 2000.
Of the 848 PCPs who opened an e-mail about the study, 165 (19.5%) responded. The majority of respondents (88%) spent at least half of their time in clinical care, and 46% were in private practice, said Dr. Abdel-Kader of the department of medicine at Vanderbilt University in Nashville, Tenn.
Nearly all respondents (96%) felt that glomerular filtration rate (GFR) values were helpful, while 75% and 91% reported testing for albuminuria in nondiabetic hypertensive patients with an estimated GFR (eGFR) of greater than 60 mL/min per 1.73 m2 or less than 60 mL/min per 1.73 m2, respectively. "However, frequent barriers cited included a lack of effect on management, limited time, and the perceived absence of guidelines recommending albuminuria testing," Dr. Abdel-Kader said.
"While PCPs expressed very high agreement with the definition of CKD in patients with marked decrements in eGFR (eGFR less than 45 mL/min per 1.73 m2) or decrements in eGFR coupled with albuminuria, agreement was less robust when eGFR was greater than 60 mL/min per 1.73 m2 or in CKD stage 3a without albuminuria."
Most respondents (an average of 78%) felt that angiotensin-converting enzyme inhibitors and angiotensin receptor blockers improved outcomes in patients with CKD, yet agreement was lower with severe vs. moderate albuminuria (78% vs. 85%, respectively; P = .03).
Slightly more than half of primary care physicians (51%) reported being unfamiliar with chronic kidney disease guidelines, yet 75% were receptive to systematic interventions in addition to CME to improve their care of CKD patients. "The importance of albuminuria in CKD has become a point of emphasis in guidelines relatively recently, and its value in CKD may not be clearly understood by many PCPs," Dr. Abdel-Kader said. "This is likely contributing to suboptimal targeting of CKD treatments in high-risk and low-risk patients. Working with PCPs to develop systematic interventions that help streamline and improve CKD care without disrupting work flow may have significant potential to improve CKD patient care."
The survey did have certain limitations, including its low response rate, he said. "Our respondents were younger and more likely to be internists than the PCPs we targeted," he noted. "Prior studies have shown that these characteristics tend to associate with greater familiarity with CKD guidelines and recommendations. Hence, recognition of CKD and guideline familiarity may be lower in the general PCP community than we document in our survey."