Survey shows primary care docs would welcome more info on kidney disease

Las Vegas – Many primary care doctors say they are unfamiliar with guidelines on chronic kidney disease (CKD), but are willing to take steps to improve how they care for patients with CKD, according to a survey presented here at the National Kidney Foundation's 2014 Spring Clinical Meetings.

Dr. Khaled Abdel-Kader, an assistant professor of medicine at Vanderbilt University School of Medicine in Nashville, Tenn., and his colleagues sent invitations to their Internet-based survey to 12,034 primary care physicians (PCPs), 165 of whom responded.

Fifty-one percent of the survey respondents said they were not familiar with CKD guidelines, however, most agreed with guidelines defining CKD. Most PCPs reported checking for albumin in the urine of their non-diabetic patients with high blood pressure as recommended in the current CKD guidelines. This test is important for identifying patients with CKD, or with risk factors for CKD, who are at high risk of poor outcomes.

The surveyed physicians also mentioned barriers to urine testing for albumin, including the belief that the results would not change patient management, limited time and the perception that there were no guidelines to recommend testing.

While the survey didn't address patient awareness, kidney specialists “need to continue to work to help patients become more familiar with CKD risk factors,” Abdel-Kader said.

According to the National Kidney Foundation, anyone who has diabetes, high blood pressure, is 60 or older or has a family history of kidney failure is at risk and “should ask their PCPs how well their kidneys are working and to test for protein in the urine, an early sign of kidney disease.”

“Patients should discuss with their practitioner what they can do together to help minimize their risks of developing CKD or developing related complications if CKD is already present,” said Dr. Joseph Vassalotti, Chief Medical Officer at the National Kidney Foundation. “Ways to reduce risk include controlling blood sugar and blood pressure, stopping smoking, maintaining a healthy diet and regular physical activity.”

“One limitation of our survey was the low response rate,” Abdel-Kader noted. “Our respondents were younger and more likely to be internists than the PCPs we targeted. 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.”

“The National Kidney Foundation’sCKD Primary Care Initiative is designed to collaborate with PCPs to improve awareness of the value of testing for CKD and the evidence-based guideline recommendations for managing CKD. Through local education programs and symposia, we’ll be working to disseminate these guidelines to PCPs around the U.S.,” said Vassalotti.