‘Major care gaps’ found in treatment for patients with CKD in primary care clinics
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For intermediate- and high-risk patients with chronic kidney disease in primary care clinics, there are “several areas” for care improvement, according to data published in the American Journal of Kidney Diseases.
“We were not surprised to see the major care gaps remaining for patients with CKD, who are at high risk of progression,” Navdeep Tangri, MD, PhD, FRCP(C), study co-author and attending physician and associate professor in the division of nephrology in the department of internal medicine and department of community health sciences at the University of Manitoba, told Healio. “In everyday primary care practice, there is a large variety of clinical problems the physician encounters – ranging from depression, insomnia to diabetes, cancer screening and hypertension.”
To assess CKD quality of care indictors within a primary care setting, Tangri and colleagues conducted a retrospective cohort study of data for 11,035 patients with CKD who were treated at primary care clinics between Jan. 1, 2010, and Dec. 31, 2019, and had a urine albumin-to-creatinine ratio test. Data were obtained through the Canadian Primary Care Sentinel Surveillance Network.
Overall, 83% of patients had a low risk of moving toward kidney failure, 10.3% had an intermediate risk and 6.7% had a high risk.
Researchers found that only 30% of intermediate- and high-risk patients were given a nephrology referral, while 56% were on a renin-angiotensin-aldosterone system inhibitor, 38% were on a statin and 65% had a blood pressure measurement within target.
Additionally, patients with CKD stage G3 were included in a subgroup analysis, and researchers observed that use of SGLT2 inhibitors in each risk group was less than 12%.
“We cannot expect primary care physicians, who look after the majority of patients with CKD worldwide, to identify, risk stratify and treat all intermediate-/high-risk patients with CKD with goal-directed medical therapy,” Tangri told Healio. “We need to give them to tools that make it seamless – this means integrating equations, like the kidney failure risk equation (KFRE), into electronic medical records – [im]proving clinical decision support within the busy daily workflow. If we create/provide the right tools in primary care, we can have the biggest impact on the management of CKD.”
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