Recognition of CKD After the Introduction of Automated Reporting of Estimated GFR in the Veterans Health Administration

Wang, Virginia; Maciejewski, Matthew L.; Hammill, Bradley G.; Hall, Rasheeda K.; Scoyoc, Lynn Van; Garg, Amit X.; Jain, Arsh K.; Patel, Uptal D.

doi:10.2215/cjn.02490213

Cited by 17 publications

(12 citation statements)

References 28 publications

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“…This recommendation provided to live donors is consistent with the recommended PCP visit frequency for the general population as well as the early chronic kidney disease (CKD) population . Annual follow‐up for live kidney donors is critical because it facilitates health maintenance behaviors and allows for the early detection of renal function decline and subsequent clinical management . For example, in the event of CKD, timely intervention is critical to slow its progression to ESRD and to prevent comorbidities including cardiovascular disease, diabetes, and hypertension …”

Section: Introductionmentioning

confidence: 82%

Patterns of primary care utilization before and after living kidney donation

Alejo

Luo

Massie

et al. 2017

Clinical Transplantation

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Background Annual visits with a primary care provider (PCP) are recommended for living kidney donors to monitor long-term health post-donation, yet adherence to this recommendation is unknown. Methods We surveyed 1170 living donors from our center from 1970–2012 to ascertain frequency of PCP visits pre- and post-donation. Interviews occurred median (IQR) 6.6 (3.8 – 11.0) years post-transplant. We used multivariate logistic regression to examine associations between donor characteristics and PCP visit frequency. Results Overall, only 18.6% had less-than-annual PCP follow-up post-donation. The strongest predictor of post-donation PCP visit frequency was pre-donation PCP visit frequency. Donors who had less-than-annual PCP visits before donation were substantially more likely to report less-than-annual PCP visits post-donation (OR = 9.814.421.0, p<0.001). Men were more likely to report less-than-annual PCP visits post-donation (adjusted OR = 1.21.62.3, p<0.01); this association was amplified in unmarried/non-cohabiting men (aOR = 2.43.96.3, p<0.001). Donors without college education were also more likely to report less-than-annual PCP visits post-donation (aOR = 1.31.82.5, p=0.001). Conclusions The importance of annual PCP visits should be emphasized to all living donors, especially those with less education, men (particularly single men) and donors who did not see their PCP annually before donation.

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Section: Introductionmentioning

confidence: 82%

Patterns of primary care utilization before and after living kidney donation

Alejo

Luo

Massie

et al. 2017

Clinical Transplantation

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“…Introduction of the CKD stage classification scheme by CMS in 2005, whereby some measure of the severity of CKD could be quantified for billing purposes, may have been a factor. Additionally, automated reporting of eGFR on routine laboratory reporting may have contributed (14,15), but this is far from certain (16). If these suppositions are correct, they constitute a powerful public health message about how early referral to the appropriate specialist (the nephrologist) can facilitate a procedure (creation of an AVF) that results in reduced mortality in an ill and vulnerable population (patients on incident dialysis), a hypothesis backed by evidence (17).…”

Section: Discussionmentioning

confidence: 99%

The Healthy People 2020 Objectives for Kidney Disease: How Far Have We Come, and Where Do We Need to Go?

Wetmore

Liu

et al. 2016

CJASN

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The Healthy People 2020 initiative established goals for patients with CKD and ESRD. We assessed United States progress toward some of these key goals. Using data from the Centers for Medicare and Medicaid Services ESRD database, we created yearly cohorts of patients on incident and prevalent dialysis from 2000 to 2013. Change in event rate or proportion change over the study years was modeled using Poisson regression with adjustment for age, race, sex, and primary cause of ESRD. For all-cause mortality in prevalent patients, Healthy People 2020 sought approximately 0.8% relative annual improvement; actual improvement was 2.7%. Improvement was greatest for patients ages 18-44 years old (3.8%; P<0.01 versus 2.8% for ages 65-74 years old) and 2.3% even for patients ages ≥75 years old. For mortality in incident patients, the relative annual decrease was 2.1% overall, a twofold improvement over the goal; mortality decreased nearly twice as much in black as in white patients (3.2% versus 1.8%; P<0.001). Geographic variation was substantial; the relative annual decrease was 0.6% in the Midwest and more than fourfold greater (2.7%) in the South. Cardiovascular mortality in prevalent patients decreased dramatically at 5.0% per year, far exceeding the annual goal of approximately 0.8%; the decrease was greatest in patients ages ≥75 years old (5.5%; P<0.001 versus ages 65-74 years old; 5.1%). The relative annual increase in percentages of patients with a fistula at dialysis initiation was 2.4%, roughly three times the goal; the increase was greater for black than white patients (3.2% versus 2.3%; P<0.01). Adjusted regional differences varied greater than twofold: 2.0% for the South versus 4.1% for the Midwest. Thus, although gains have been substantial, not all groups have benefitted equally. Goal development for Healthy People 2030 should consider changes in goal paradigms, such as tailoring by geographic region and incorporating patient-centered goals.

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“…First, the observation period is long, and in this time, we cannot know if clinicians have changed the behavior during the observation period, especially with the accumulation of evidence on the best performance of the CKD-EPI equation compared to the MDRD appeared in recent years. Second, in our center, the value of GFR is not automatically reported by the laboratory, and provision of this information may influence the level of awareness of the clinician, although two recent studies fail to find this [32,33]. Third, given the clinical profile of patients with CKD, we cannot exclude that a proportion of older patients with multiple comorbidities were in a terminal state, so the doctor did not consider it necessary to point out the presence of CKD.…”

Section: Study Limitations and Strengthsmentioning

confidence: 96%

Clinical implications of the CKD epidemiology collaboration (CKD-EPI) equation compared with the modification of diet in renal disease (MDRD) study equation for the estimation of renal dysfunction in patients with cardiovascular disease

Tarantini

Barbati²,

Cioffi

et al. 2015

Intern Emerg Med

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The CKD-EPI equation is more accurate than the MDRD equation in the general population. We performed this study to establish whether chronic kidney disease (CKD) is commonly recognized by clinicians and whether the CKD-EPI equation improves prognosis estimation in patients with chronic cardiovascular disease (CVD). We analyzed data on 12394 CVD patients consecutively examined at the Cardiovascular Center of Trieste (Italy) between November 2009 and October 2013. The outcomes were all-cause death and a composite outcome of death/hospitalization for CV events (D+cvH). CKD-EPI formula reclassified 1786 (14.4 %) patients between KDIGO categories compared to the MDRD: 2.3 % (n = 280) placed in a lower risk and 12.1 % (n = 1506) into a higher risk group. CKD, defined as eGFR-CKD-EPI formula <60 ml/min, was present in 3083 patients (24.9 %) but not recognized by clinicians in 1946 (63.1 % of patients with CKD). The lack of recognition of CKD was inversely proportional to the KDIGO class for both equations. There were 986 deaths and 2726 D+cvH during 24 months follow-up. The incidence of death and D+cvH was about twice as high in patients with unrecognized CKD than in those with normal renal function (31 % vs. 17.1 %, aHR: 1.35, 95 % CI: 1.15 to 1.60), even in those patients with eGFR-MDRD >60 but eGFR-CKD-EPI formula <60 (31.1 % vs 17.1 %, p < 0.001). CKD-EPI equation provides more accurate risk stratification than MDRD equation in patients with CVD. CKD was unrecognized in nearly two-thirds of these patients but clinical outcomes were similar in those for patients with recognized CKD.

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Recognition of CKD After the Introduction of Automated Reporting of Estimated GFR in the Veterans Health Administration

Cited by 17 publications

References 28 publications

Patterns of primary care utilization before and after living kidney donation

Patterns of primary care utilization before and after living kidney donation

The Healthy People 2020 Objectives for Kidney Disease: How Far Have We Come, and Where Do We Need to Go?

Clinical implications of the CKD epidemiology collaboration (CKD-EPI) equation compared with the modification of diet in renal disease (MDRD) study equation for the estimation of renal dysfunction in patients with cardiovascular disease

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