Adherence to chronic kidney disease guidelines in primary care patients is associated with comorbidity

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Title:	Adherence to chronic kidney disease guidelines in primary care patients is associated with comorbidity
Author(s):	Dipten, C. van; Berkel, S. van; Gelder, V.A. van; Wetzels, J.F.M. ; Akkermans, R.P. ; Grauw, W.J.C. de ; Biermans, M.C.J. ; Haan, N.D. de ; Assendelft, W.J.J.
Publication year:	2017
Source:	Family Practice, vol. 34, iss. 4, (2017), pp. 459-466
ISSN:	0263-2136
DOI:	https://doi.org/10.1093/fampra/cmx002
Publication type:	Article / Letter to editor
Please use this identifier to cite or link to this item : https://hdl.handle.net/2066/177615
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Subject:	Radboudumc 11: Renal disorders RIHS: Radboud Institute for Health Sciences Radboudumc 16: Vascular damage RIHS: Radboud Institute for Health Sciences Radboudumc 18: Healthcare improvement science RIHS: Radboud Institute for Health Sciences Tijdelijke code tbv inlezen publicaties Radboudumc - Alleen voor gebruik door Radboudumc
Organization:	Primary and Community Care Nephrology IQ Healthcare
Journal title:	Family Practice
Volume:	vol. 34
Issue:	iss. 4
Page start:	p. 459
Page end:	p. 466
Abstract:	Background: GPs insufficiently follow guidelines regarding consultation and referral for chronic kidney disease (CKD). Objective: To identify patient characteristics and quality of care (QoC) in CKD patients with whom consultation and referral recommendations were not followed. Method: A 14 month prospective observational cohort study of primary care patients with CKD stage 3-5. 47 practices participated, serving 207469 people. 2547 CKD patients fulfilled consultation criteria, 225 fulfilled referral criteria. We compared characteristics of patients managed by GPs with patients receiving nephrologist co-management. We assessed QoC as adherence to monitoring criteria, CKD recognition and achievement of blood pressure (BP) targets. Results: Patients treated in primary care despite a consultation recommendation (94%) had higher eGFR values (OR 1.07; 95% CI: 1.05-1.09), were less often monitored for renal function (OR 0.42; 95% CI: 0.24-0.74) and potassium (OR 0.56; 95% CI: 0.35-0.92) and CKD was less frequently recognised (OR 0.46; 95% CI: 0.31-0.68) than in patients with nephrologist co-management. Patients treated in primary care despite referral recommendation (70%) were older (OR 1.03; 95% CI:1.01-1.06) and had less cardiovascular disease (OR 0.37; 95% CI: 0.19-0.73). Overall, in patients solely managed by GPs, CKD recognition was 50%, monitoring disease progression in 36% and metabolic parameters in 3%, BP targets were achieved in 51%. Monitoring of renal function and BP was positively associated with diabetes (OR 3.10; 95% CI: 2.47-3.88 and OR 7.78; 95% CI: 3.21-18.87) and hypertension (OR 3.19; 95% CI: 2.67-3.82 and OR 3.35; 95% CI: 1.45-7.77). Conclusion: Patients remaining in primary care despite nephrologists' co-management recommendations were inadequately monitored, and BP targets were insufficiently met. CKD patients without cardiovascular comorbidity or diabetes require extra attention to guarantee adequate monitoring of renal function and BP.