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Detection and awareness of moderate to advanced CKD by primary care practitioners: a cross-sectional study from Italy.
Am J Kidney Dis. 2008 Sep; 52(3):444-53.AJ

Abstract

BACKGROUND

Chronic kidney disease (CKD) is a strong independent predictor of cardiovascular disease. Although general practitioners (GPs) represent the first line for identification of these high-risk patients, their diagnostic approach to CKD is ill defined.

STUDY DESIGN

Cross-sectional evaluation of database of Italian GPs.

SETTING & PARTICIPANTS

Representative sample of adult Italian population regularly followed up by GPs in 2003.

OUTCOMES

Frequency of serum creatinine testing, prevalence of CKD (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m(2)), awareness of CKD assessed from use of diagnostic codes (Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]) for CKD, and referral to nephrologists.

RESULTS

Of 451,548 individuals in the entire practice population, only 77,630 (17.2%) underwent serum creatinine testing. Female sex (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.06 to 1.12), advanced age (OR, 2.70; 95% CI, 2.63 to 2.78), diabetes (OR, 1.31; 95% CI, 1.20 to 1.42), hypertension (OR, 1.10; 95% CI, 1.02 to 1.19), autoimmune diseases (OR, 1.42; 95% CI, 1.11 to 1.82), and recurrent urinary tract infections (OR, 1.63; 95% CI, 1.10 to 2.42) were all associated with serum creatinine testing. Conversely, use of either nonsteroidal anti-inflammatory drugs (OR, 1.03; 95% CI, 0.89 to 1.21) or aminoglycosides or contrast media (OR, 0.78; 95% CI, 0.54 to 1.14) was not associated with serum creatinine testing. In the subgroup with serum creatinine data, the age-adjusted prevalence of CKD was 9.33% (11.93% in women, 6.49% in men). However, in patients with eGFR less than 60 mL/min/1.73 m(2), serum creatinine values were apparently normal (<1.2 mg/dL in women, <1.4 mg/dL in men) in 54%, and GPs used ICD-9-CM codes for CKD in only 15.2%. Referral to nephrologists ranged from 4.9% for patients with eGFR of 59 to 30 mL/min/1.73 m(2) to 55.7% for those with eGFR less than 30 mL/min/1.73 m(2).

LIMITATIONS

The prevalence of decreased kidney function may be overestimated because of the more frequent serum creatinine testing in sicker individuals and lack of creatinine calibration.

CONCLUSIONS

In primary care, CKD stages 3 to 5 are frequent, but its awareness is scarce because of limited rates of serum creatinine testing and difficulty recognizing decreased eGFR in the absence of increased serum creatinine testing.

Authors+Show Affiliations

Department of Nephrology, Second University of Naples, Naples, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18468747

Citation

Minutolo, Roberto, et al. "Detection and Awareness of Moderate to Advanced CKD By Primary Care Practitioners: a Cross-sectional Study From Italy." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 52, no. 3, 2008, pp. 444-53.
Minutolo R, De Nicola L, Mazzaglia G, et al. Detection and awareness of moderate to advanced CKD by primary care practitioners: a cross-sectional study from Italy. Am J Kidney Dis. 2008;52(3):444-53.
Minutolo, R., De Nicola, L., Mazzaglia, G., Postorino, M., Cricelli, C., Mantovani, L. G., Conte, G., & Cianciaruso, B. (2008). Detection and awareness of moderate to advanced CKD by primary care practitioners: a cross-sectional study from Italy. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 52(3), 444-53. https://doi.org/10.1053/j.ajkd.2008.03.002
Minutolo R, et al. Detection and Awareness of Moderate to Advanced CKD By Primary Care Practitioners: a Cross-sectional Study From Italy. Am J Kidney Dis. 2008;52(3):444-53. PubMed PMID: 18468747.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Detection and awareness of moderate to advanced CKD by primary care practitioners: a cross-sectional study from Italy. AU - Minutolo,Roberto, AU - De Nicola,Luca, AU - Mazzaglia,Giampiero, AU - Postorino,Maurizio, AU - Cricelli,Claudio, AU - Mantovani,Lorenzo G, AU - Conte,Giuseppe, AU - Cianciaruso,Bruno, Y1 - 2008/05/12/ PY - 2007/09/05/received PY - 2008/03/03/accepted PY - 2008/5/13/pubmed PY - 2008/9/19/medline PY - 2008/5/13/entrez SP - 444 EP - 53 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 52 IS - 3 N2 - BACKGROUND: Chronic kidney disease (CKD) is a strong independent predictor of cardiovascular disease. Although general practitioners (GPs) represent the first line for identification of these high-risk patients, their diagnostic approach to CKD is ill defined. STUDY DESIGN: Cross-sectional evaluation of database of Italian GPs. SETTING & PARTICIPANTS: Representative sample of adult Italian population regularly followed up by GPs in 2003. OUTCOMES: Frequency of serum creatinine testing, prevalence of CKD (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m(2)), awareness of CKD assessed from use of diagnostic codes (Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]) for CKD, and referral to nephrologists. RESULTS: Of 451,548 individuals in the entire practice population, only 77,630 (17.2%) underwent serum creatinine testing. Female sex (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.06 to 1.12), advanced age (OR, 2.70; 95% CI, 2.63 to 2.78), diabetes (OR, 1.31; 95% CI, 1.20 to 1.42), hypertension (OR, 1.10; 95% CI, 1.02 to 1.19), autoimmune diseases (OR, 1.42; 95% CI, 1.11 to 1.82), and recurrent urinary tract infections (OR, 1.63; 95% CI, 1.10 to 2.42) were all associated with serum creatinine testing. Conversely, use of either nonsteroidal anti-inflammatory drugs (OR, 1.03; 95% CI, 0.89 to 1.21) or aminoglycosides or contrast media (OR, 0.78; 95% CI, 0.54 to 1.14) was not associated with serum creatinine testing. In the subgroup with serum creatinine data, the age-adjusted prevalence of CKD was 9.33% (11.93% in women, 6.49% in men). However, in patients with eGFR less than 60 mL/min/1.73 m(2), serum creatinine values were apparently normal (<1.2 mg/dL in women, <1.4 mg/dL in men) in 54%, and GPs used ICD-9-CM codes for CKD in only 15.2%. Referral to nephrologists ranged from 4.9% for patients with eGFR of 59 to 30 mL/min/1.73 m(2) to 55.7% for those with eGFR less than 30 mL/min/1.73 m(2). LIMITATIONS: The prevalence of decreased kidney function may be overestimated because of the more frequent serum creatinine testing in sicker individuals and lack of creatinine calibration. CONCLUSIONS: In primary care, CKD stages 3 to 5 are frequent, but its awareness is scarce because of limited rates of serum creatinine testing and difficulty recognizing decreased eGFR in the absence of increased serum creatinine testing. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/18468747/Detection_and_awareness_of_moderate_to_advanced_CKD_by_primary_care_practitioners:_a_cross_sectional_study_from_Italy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(08)00576-3 DB - PRIME DP - Unbound Medicine ER -