Chronic kidney disease monitoring in Australian general practice

Khanam, Masuma Akter; Kitsos, Alex; Stankovich, Jim; Castelino, Ronald L.; Jose, Matthew; Kinsman, Leigh; Peterson, Gregory M.; Wimmer, Barbara C.; Zaidi, Syed Tabish Razi; Radford, Jan

doi:10.31128/ajgp-07-18-4630

Cited by 11 publications

(17 citation statements)

References 16 publications

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“…The most striking finding, characterised by high variation combined with the lowest achievement rate, concerned albuminuria monitoring in patients with established CKD. Our results revealed even lower albuminuria testing rates than studies from Australia [ 11 ], the Netherlands [ 38 ] and Canada [ 10 , 14 ]. The difference may in part be explained by inclusion of patients in all CKD stages into our cohort, as opposed to restriction to stages G3 or higher in most of these studies.…”

Section: Discussioncontrasting

confidence: 77%

“…We identified CKD patients by means of the KDIGO laboratory definition and obtained a cohort aged 80 years in median with 58% women, a demographic close to that of similar studies [ 11 , 12 ]. The advanced age of CKD patients in general practice contrasts with the study populations of most clinical trials addressing advanced CKD [ 33 ], which poses an important challenge to guideline applicability.…”

Section: Discussionmentioning

confidence: 99%

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Quality and variation of care for chronic kidney disease in Swiss general practice: A retrospective database study

et al. 2022

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Background Chronic kidney disease (CKD) is a common condition in general practice. Data about quality and physician-level variation of CKD care provided by general practitioners is scarce. In this study, we evaluated determinants and variation of achievement of 14 quality indicators for CKD care using electronic medical records data from Swiss general practice during 2013–2019. Methods We defined two patient cohorts from 483 general practitioners, one to address renal function assessment in patients with predisposing conditions (n = 47,201, median age 68 years, 48.7% female) and one to address care of patients with laboratory-confirmed CKD (n = 14,654, median age 80 years, 57.5% female). We investigated quality indicator achievement with mixed-effect logistic regression and expressed physician-level variation as intraclass correlation coefficients (ICCs) and range odds ratios (rORs). Results We observed the highest quality indicator achievement rate for withholding non-steroidal anti-inflammatory drug prescription in patients with CKD staged G2–3b within 12 months of follow-up (82.6%), the lowest for albuminuria assessment within 18 months of follow-up (18.1%). Highest physician-level variation was found for renal function assessment during 18 months of follow-up in patients with predisposing conditions (diabetes: ICC 0.31, rOR 26.5; cardiovascular disease: ICC 0.28, rOR 17.4; hypertension: ICC 0.24, rOR 17.2). Conclusion This study suggests potentially unwarranted variation in general practice concerning RF assessment in patients affected by conditions predisposing for CKD. We further identified potential gaps in quality of CKD monitoring as well as lower quality of CKD care for female patients and patients not affected by comorbidities.

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Section: Discussioncontrasting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Quality and variation of care for chronic kidney disease in Swiss general practice: A retrospective database study

et al. 2022

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“…This is a familiar picture demonstrated in similar high-income settings. 66,159 The proliferation of guideline recommendations targeting primary care, however, constitutes a barrier in itself to sustainable implementation of optimal management of chronic diseases including CKD. 66,[159][160][161] For example, an average primary care physician would require about 7-10 hours per working day to follow preventive recommendations for the common chronic diseases.…”

mentioning

confidence: 99%

“…66,159 The proliferation of guideline recommendations targeting primary care, however, constitutes a barrier in itself to sustainable implementation of optimal management of chronic diseases including CKD. 66,[159][160][161] For example, an average primary care physician would require about 7-10 hours per working day to follow preventive recommendations for the common chronic diseases. 162,163 Conclusion Prevention of CKD is possible but requires a broad and holistic approach-ranging from good governance and achievement of the sustainable development goals, to ensuring healthy pregnancies for a good start in lifeand access to appropriate screening for early detection and treatment of risk factors for CKD as well as of early CKD ( Figure 2).…”

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confidence: 99%

Preventing CKD in Developed Countries

Luyckx

Cherney

Bello

2020

Kidney International Reports

108

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Chronic kidney disease (CKD) is an important public health concern in developed countries because of both the number of people affected and the high cost of care when prevention strategies are not effectively implemented. Prevention should start at the governance level with the institution of multisectoral polices supporting sustainable development goals and ensuring safe and healthy environments. Primordial prevention of CKD can be achieved through implementation of measures to ensure healthy fetal (kidney) development. Public health strategies to prevent diabetes, hypertension, and obesity as risk factors for CKD are important. These approaches are cost-effective and reduce the overall noncommunicable disease burden. Strategies to prevent nontraditional CKD risk factors, including nephrotoxin exposure, kidney stones, infections, environmental exposures, and acute kidney injury (AKI), need to be tailored to local needs and epidemiology. Early diagnosis and treatment of CKD risk factors such as diabetes, obesity, and hypertension are key for primary prevention of CKD. CKD tends to occur more frequently and to progress more rapidly among indigenous, minority, and socioeconomically disadvantaged populations. Special attention is required to meet the CKD prevention needs of these populations. Effective secondary prevention of CKD relies on screening of individuals at risk to detect and treat CKD early, using established and emerging strategies. Within high-income countries, barriers to accessing effective CKD therapies must be recognized, and public health strategies must be developed to overcome these obstacles, including training and support at the primary care level to identify individuals at risk of CKD, and appropriately implement clinical practice guidelines.

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“…Testing for urinary albumin with a formal uACR through a laboratory remains suboptimal yet is consistent with practice across Australia [ 17 ]. Khanam et al, using the Medicine Insight dataset from Australian general Practices reported 19.7% of Australians with stage G3 CKD had a uACR tested in an 18-month period, but this increased to 68.7% if diabetic [ 17 ]. It is possible that a dipstick urinalysis is being used for testing for albuminuria or proteinuria, instead of the recommended uACR.…”

Section: Discussionmentioning

confidence: 99%

Island medicine: using data linkage to establish the kidney health of the population of Tasmania, Australia.

Jose

Rajesh

Jose

et al. 2021

IJPDS

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ObjectiveTo report (using linked laboratory data) the incidence, prevalence and geographic variation of chronic kidney disease (CKD) across the whole island population of Tasmania, Australia. MethodsA retrospective cohort study (the Tasmanian Chronic Kidney Disease study (CKD.TASlink)) using linked data from five health and two pathology datasets from the island state of Tasmania, Australia between 1/1/2004 and 31/12/2017. We used data on 460,737 Tasmanian adults (aged 18 years and older, representing 86.8% of the state's population) who had a serum creatinine measured during the study period. We defined CKD as per Kidney Disease Outcomes Quality Initiative, requiring two measures of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2, at least three months apart. Kidney replacement therapy (KRT) included dialysis or kidney transplantation. ResultsWe identified 56,438 Tasmanians with CKD during the study period, equating to an age-standardised annual incidence of 1.0% and a prevalence of 6.5%. These figures were higher in women, older Tasmanians and people living in the North-West region of Tasmania. Testing for urinary albumin:creatinine ratio is increasing, with 28.5% of women and 30.8% of men with stage 3 CKD having both an eGFR and uACR in 2017. Use of KRT was consistently seen in >65% of Tasmanians with eGFR <15mL/min/1.73m2. ConclusionThere is geographic and gender variation in the incidence and prevalence of CKD, but it is reassuring to see that the majority of people with end-stage kidney failure are actually receiving treatment with dialysis or transplantation.

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Chronic kidney disease monitoring in Australian general practice

Cited by 11 publications

References 16 publications

Quality and variation of care for chronic kidney disease in Swiss general practice: A retrospective database study

Quality and variation of care for chronic kidney disease in Swiss general practice: A retrospective database study

Preventing CKD in Developed Countries

Island medicine: using data linkage to establish the kidney health of the population of Tasmania, Australia.

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