Reporting of estimated glomerular filtration rate: Effect on physician recognition of chronic kidney disease and prescribing practices for elderly hospitalized patients

Abstract

BACKGROUNDPhysician recognition of chronic kidney disease (CKD) in elderly patients has been noted to be poor. These patients are at increased risk of medication dosing errors and acute renal failure.OBJECTIVETo investigate the effect of reporting estimated glomerular filtration rate (GFR) of elderly hospitalized patients on physician recognition of CKD and physician prescribing behaviors.DESIGNA retrospective combined with a prospective medical record review project.SETTINGA large academic medical center.PATIENTSPatients included were 65 years of age or older and had creatinine values within the normal laboratory range (< 1.6 mg/dL).INTERVENTIONReporting a calculated estimate of GFR to physicians.MEASUREMENTSRates of recognition of CKD were examined before and after the intervention. The effects of the intervention on prescription of renal‐dosed antibiotics and nonsteroidal anti‐inflammatory drugs (NSAIDS) and cyclooxygenase‐ 2 inhibitors (COX‐2) at hospital discharge were assessed.RESULTSA total of 260 and 198 patients were included before and after the intervention, respectively. Recognition of chronic kidney disease was low in both groups but demonstrated a significant increase following reporting of estimated GFR (3.9% to 12.6%, P < .001). Reporting of GFR was not associated with a significant decrease in prescription of NSAID/COX‐2 medications or increased rates of correct dosing of antibiotics (P = .10 and P = .81, respectively).CONCLUSIONSAlthough reporting of estimated GFR was associated with improved physician recognition of CKD in elderly hospitalized patients, it did not lead to a change in physician prescribing. More extensive interventions are necessary to increase recognition and decrease medication dosing errors. Journal of Hospital Medicine 2007;2:74–78. © 2007 of Hospital Medicine.

Dosing Errors in Prescribed Antibiotics for Older Persons With CKD: A Retrospective Time Series Analysis

“…The authors concluded that although eGFR reporting improved recognition of CKD among physicians, it did not lead to a change in physician prescribing behavior. Based on our results and those of Quartarolo et al, 31 we believe that poor knowledge of renal dosing …”

Recognition and Management of Chronic Kidney Disease in an Elderly Ambulatory Population

“…At least 3 studies have assessed the effects of eGFR reporting on clinician recognition and behavior. [17][18][19] Two of these, which included only reporting, found only modest increases in physician recognition. A third study, which included an educational intervention as well, noted a 4-fold increase in detection rates.…”

“…[17][18][19] Whether such recognition leads to changes in physician practice which may slow the progression of chronic kidney disease is unclear. Specifically, if CKD is recognized, are physicians more likely to prescribe ACE inhibitors or ARBs, and are they less likely to prescribe drugs that are nephrotoxic or have increased side effects in CKD?…”

eGFR

“…Although nephrology consultation may often be needed, we do not see it as mandatory or even desirable in every case. Publications reviewing experiences with eGFR suggest that reporting it increases awareness of CKD but emphasize the need for education as an adjunct (27)(28)(29)(30). The American Society of Nephrology in collaboration with the National Kidney Disease Education Program provides a free slide set at its web site.…”