Study: Doctors are missing CKD

September 08, 2006

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Simple algorithm predicts chronic kidney disease

Do you recognize patients at risk for kidney disease?

Not as well as you could, reports one study. When presented with a hypothetical patient who has signs of chronic kidney disease (CKD), only 59% of FPs and 78% of internists surveyed made the correct choices of which tests to order and whether to refer. In contrast, 97% of nephrologists presented with the same patient took the right course.

“We, as physicians, can certainly do better,” according to L. Ebony Boulware, MD, MPH, the study’s lead author and an assistant professor of medicine at The Johns Hopkins University School of Medicine in Baltimore. Randomly selected physicians (89 FPs, 89 general internists, and 126 nephrologists) reviewed lab values, signs, and symptoms of a hypothetical 50-year-old woman. Doctors had enough clinical information to estimate the patient’s glomerular filtration rate, which suggested CKD that had progressed from stage 3 to stage 4 in the preceding four months.

Wrote Dr. Boulware: “Efforts to raise physicians’ awareness of progressive chronic kidney disease and disseminate recently developed clinical practice guidelines have not been as effective as hoped.”

Surveyed FPs and internists who had more than 10 years of clinical practice were least likely to recognize CKD and least likely to refer.

Bottom line:

“Simply put, our study shows that primary-care physicians are not recognizing kidney disease in high-risk patients as often as they should,” says Dr. Boulware.