scholarly journals Referring patients with chronic kidney disease back to primary care: a criteria-based analysis in outpatient renal clinics

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Carola van Dipten ◽  
Davy Gerda Hermina Antoin van Dam ◽  
Wilhelmus Joannes Carolus de Grauw ◽  
Marcus Antonius Gerard Jan ten Dam ◽  
Marcus Matheus Hendrik Hermans ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
General Practitioners ◽  
Estimated Glomerular Filtration Rate ◽  
Outpatient Clinics ◽  
Future Research ◽  
Care Facilities ◽  
Nephrology Care

Abstract Background The increased demand for nephrology care for patients with chronic kidney disease (CKD) necessitates a critical review of the need for secondary care facilities and the possibilities for referral back to primary care. This study aimed to evaluate the characteristics and numbers of patients who could potentially be referred back to primary care, using predefined criteria developed by nephrologists and general practitioners. Method We organised a consensus meeting with eight nephrologists and two general practitioners to define the back referral (BR) criteria, and performed a retrospective cohort study reviewing records from patients under nephrologist care in three hospitals. Results We reached a consensus about the BR criteria. Overall, 78 of the 300 patients (26%) in the outpatient clinics met the BR criteria. The characteristics of the patients who met the BR criteria were: 56.4% male, a median age of 70, an average of 3.0 outpatients visits per year, and a mean estimated glomerular filtration rate of 46 ml/min/1,73m2. Hypertension was present in 67.9% of this group, while 27.3% had diabetes and 16.9% had cancer. The patients who could be referred back represented all CKD stages except stage G5. The most common stage (16%) was G3bA2 (eGFR 30 ≤ 44 and ACR 3 ≤ 30). Conclusion A substantial proportion of patients were eligible for referral back to primary care. These patients often have a comorbidity, such as hypertension or diabetes. Future research should focus on generalisability of the BR criteria, the feasibility of actual implementation of the back referral, follow-up assessments of renal function and patient satisfaction.

scholarly journals HbA1c in a primary care cohort with diabetes and chronic kidney disease: the East and North Hertfordshire Institute of Diabetes and Endocrinology (ENHIDE) Diabetes Renal Telehealth Project

2020 ◽  
Vol 20 (2) ◽  
pp. 130-137
Author(s):  
Peter H Winocour ◽  
Karen Moore-Haines ◽  
Keith Sullivan ◽  
Anne Currie ◽  
Andrew Solomon ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Hospital Admissions ◽  
Dietary Management ◽  
Creatinine Ratio ◽  
Comprehensive Review

Aim: Diabetes mellitus and chronic kidney disease (CKD) commonly co-occur. Control of glycaemia is nuanced, and should be individualised. The Diabetes Renal Telehealth Project identified 2,356 adults with diabetes and CKD, and evaluated determinants and patterns of HbA1c in order to identify under-treatment or potential over-treatment of glycaemia.Method: Comprehensive review of GP diabetes registers by the clinical investigators.Results: The study subjects (52% male, 48% female) were aged 77 years (range 19–103) with median estimated glomerular filtration rate 52 (range 3–171) mL/min and median albumin to creatinine ratio 34 (range <0.05–1428) mg/mmol. 81% were solely managed in primary care. Median HbA1c was 57 (range 10–148) mmol/mol (7.4% (3.1–15.7%)) and at the 58 mmol/mol target in 64%. Anaemia was present in 31%. 22% were solely on dietary management, 29% on insulin therapy (6 in 10 of whom were also on additional agents) and 19% were on sulfonylurea (8 in 10 of whom were on additional agents excluding insulin). Patterns of HbA1c over 2 years were stable for 44%, variable in 19%, rising in 12% and improved in 8%. The 13% initially considered at increased hypoglycaemic risk based on HbA1c measures alone had worse renal function and were more frequently anaemic (both p<0.0005), and 83% were treated with insulin and/or sulfonylureas. Hypoglycaemia hospital admissions were low with 10 people admitted over the study period. There was a reduction in age with increasing quintiles of HbA1c, and those with HbA1c >75 mmol/mol (9.0%) were youngest (mean age 68 years, p<0.001).Conclusions: The majority of people with diabetes and CKD are elderly and managed in primary care, with anaemia in 31%, potentially affecting HbA1c interpretation. Iatrogenic hypoglycaemic risk was identified in 10%, with suboptimal glycaemic control (HbA1c >9% (75 mmol/mol)) through under-treatment in 9%. This study uncovered unmet clinical need, requiring both escalation and de-escalation of glycaemic therapies. 

scholarly journals The Impact of Immunosuppression on Chronic Kidney Disease in People Living With Human Immunodeficiency Virus: The D:A:D Study

2020 ◽  
Author(s):  
Lene Ryom ◽  
Jens D Lundgren ◽  
Peter Reiss ◽  
Mike Ross ◽  
Ole Kirk ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Human Immunodeficiency Virus ◽  
Kidney Disease ◽  
Estimated Glomerular Filtration Rate ◽  
Incidence Rate Ratio ◽  
Current Time ◽  
Immunodeficiency Virus ◽  
Time Lagged ◽  
The Impact

Abstract Background Relations between different measures of human immunodeficiency virus–related immunosuppression and chronic kidney disease (CKD) remain unknown. Methods Immunosuppression measures included baseline, current, time-lagged and nadir CD4, years and percentage of follow-up (%FU) with CD4 ≤200 cells/μL, and CD4 recovery. CKD was defined as confirmed estimated glomerular filtration rate &lt;60 mL/minute/1.73 m2. Results Of 33 791 persons, 2226 developed CKD. Univariably, all immunosuppression measures predicted CKD. Multivariably, the strongest predictor was %FU CD4 ≤200 cells/μL (0 vs &gt;25%; incidence rate ratio [IRR], 0.77 [95% confidence interval [CI], .68–.88]), with highest effect in those at low D:A:D CKD risk (IRR, 0.45 [95% CI, .24–.80]) vs 0.80 [95% CI, .70–.93]). Conclusions Longer immunosuppression duration most strongly predicts CKD and affects persons at low CKD risk more.

scholarly journals Non-steroidal anti-inflammatory drugs in chronic kidney disease: a systematic review of prescription practices and use in primary care

2019 ◽  
Vol 13 (1) ◽  
pp. 63-71 ◽  
Author(s):  
Claire Lefebvre ◽  
Jade Hindié ◽  
Michael Zappitelli ◽  
Robert W Platt ◽  
Kristian B Filion
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Observational Research ◽  
Quality Improvement Intervention ◽  
Future Research ◽  
Cross Sectional ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Abstract Background Chronic kidney disease (CKD) management focuses on limiting further renal injury, including avoiding nephrotoxic medications such as non-steroidal anti-inflammatory drugs (NSAIDs). We performed a systematic review to evaluate the prevalence of primary care NSAID prescribing in this population. Methods We systematically searched MEDLINE and Embase from inception to October 2017 for observational studies examining NSAID prescribing practices or use in CKD patients in a primary care setting. The methodological quality of included studies was assessed independently by two authors using a modified version of the Agency for Healthcare Research and Quality’s Methodological Evaluation of Observational Research checklist. Results Our search generated 8055 potentially relevant publications, 304 of which were retrieved for full-text review. A total of 14 studies from 13 publications met our inclusion criteria. There were eight cohort and three cross-sectional studies, two quality improvement intervention studies and one prospective survey, representing a total of 49 209 CKD patients. Cross-sectional point prevalence of NSAID use in CKD patients ranged from 8 to 21%. Annual period prevalence rates ranged from 3 to 33%. Meta-analysis was not performed due to important clinical heterogeneity across study populations. Conclusions Evidence suggests that NSAID prescriptions/use in primary care among patients with CKD is variable and relatively high. Future research should explore reasons for this to better focus knowledge translation interventions aimed at reducing NSAID use in this patient population.

scholarly journals Mineralocorticoid Receptor Antagonist Use and Hard Renal Outcomes in Real-World Patients With Chronic Kidney Disease

Hypertension ◽  
2022 ◽  
Author(s):  
Tatsufumi Oka ◽  
Yusuke Sakaguchi ◽  
Koki Hattori ◽  
Yuta Asahina ◽  
Sachio Kajimoto ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
Real World ◽  
Estimated Glomerular Filtration Rate ◽  
Mineralocorticoid Receptor Antagonist ◽  
Therapy Initiation ◽  
Renal Replacement Therapy Initiation

Background: Real-world evidence about mineralocorticoid receptor antagonist (MRA) use has been limited in chronic kidney disease, particularly regarding its association with hard renal outcomes. Methods: In this retrospective cohort study, adult chronic kidney disease outpatients referred to the department of nephrology at an academic hospital between January 2005 and December 2018 were analyzed. The main inclusion criteria were estimated glomerular filtration rate ≥10 and <60 mL/min per 1.73 m 2 and follow-up ≥90 days. The exposure of interest was MRA use, defined as the administration of spironolactone, eplerenone, or potassium canrenoate. The primary outcome was renal replacement therapy initiation, defined as the initiation of chronic hemodialysis, peritoneal dialysis, or kidney transplantation. A marginal structural model using inverse probability of weighting was applied to account for potential time-varying confounders. Results: Among a total of 3195 patients, the median age and estimated glomerular filtration rate at baseline were 66 years and 38.4 mL/min per 1.73 m 2 , respectively. During follow-up (median, 5.9 years), 770 patients received MRAs, 211 died, and 478 started renal replacement therapy. In an inverse probability of weighting-weighted pooled logistic regression model, MRA use was significantly associated with a 28%-lower rate of renal replacement therapy initiation (hazard ratio, 0.72 [95% CI, 0.53–0.98]). The association between MRA use and renal replacement therapy initiation was dose-dependent ( P for trend <0.01) and consistent across patient subgroups. The incidence of hyperkalemia (>5.5 mEq/L) was somewhat higher in MRA users but not significant (hazard ratio, 1.14 [95% CI, 0.88–1.48]). Conclusions: MRA users showed a better renal prognosis across various chronic kidney disease subgroups in a real-world chronic kidney disease population.

Laboratory investigation and follow-up of chronic kidney disease stage 3 in primary care

2011 ◽  
Vol 412 (11-12) ◽  
pp. 1138-1142 ◽  
Author(s):  
Kristin M. Aakre ◽  
Geir Thue ◽  
Einar Svarstad ◽  
Øyvind Skadberg ◽  
Sverre Sandberg
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Laboratory Investigation ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage

scholarly journals Associations of fibroblast growth factor 23, vitamin D and parathyroid hormone with 5-year outcomes in a prospective primary care cohort of people with chronic kidney disease stage 3

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016528 ◽  
Author(s):  
Adam Shardlow ◽  
Natasha J McIntyre ◽  
Richard J Fluck ◽  
Christopher W McIntyre ◽  
Maarten W Taal
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Vitamin D Deficiency ◽  
Fibroblast Growth Factor 23 ◽  
Fibroblast Growth ◽  
Ckd Stage ◽  
All Cause Mortality

ObjectivesVitamin D deficiency, elevated fibroblast growth factor 23 (FGF23) and elevated parathyroid hormone (PTH) have each been associated with increased mortality in people with chronic kidney disease (CKD). Previous studies have focused on the effects of FGF23 in relatively advanced CKD. This study aims to assess whether FGF23 is similarly a risk factor in people with early CKD, and how this risk compares to that associated with vitamin D deficiency or elevated PTH.DesignProspective cohort study.SettingThirty-two primary care practices.ParticipantsOne thousand six hundred and sixty-four people who met Kidney Disease: Improving Global Outcomes (KDIGO) definitions for CKD stage 3 (two measurements of estimated glomerular filtration rate (eGFR) between 30 and 60 mL/min/1.73 m2at least 90 days apart) prior to study recruitment.Outcome measuresAll-cause mortality over the period of study follow-up and progression of CKD defined as a 25% fall in eGFR and a drop in GFR category, or an increase in albuminuria category.ResultsTwo hundred and eighty-nine participants died during the follow-up period. Vitamin D deficiency (HR 1.62, 95% CI 1.01 to 2.58) and elevated PTH (HR 1.42, 95% CI 1.09 to 1.84) were independently associated with all-cause mortality. FGF23 was associated with all-cause mortality in univariable but not multivariable analysis. Fully adjusted multivariable models of CKD progression showed no association with FGF23, vitamin D status or PTH.ConclusionsIn this cohort of predominantly older people with CKD stage 3 and low risk of progression, vitamin D deficiency and elevated PTH were independent risk factors for all-cause mortality but elevated FGF23 was not. While FGF23 may have a role as a risk marker in high-risk populations managed in secondary care, our data suggest that it may not be as important in CKD stage 3, managed in primary care.Trial registration numberNational Institute for Health Research Clinical Research Portfolio Study Number 6632.

scholarly journals Gustatory Function and the Uremic Toxin, Phosphate, Are Modulators of the Risk of Vascular Calcification among Patients with Chronic Kidney Disease: A Pilot Study

Toxins ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 420
Author(s):  
Shih-I Chen ◽  
Chin-Ling Chiang ◽  
Chia-Ter Chao ◽  
Chih-Kang Chiang ◽  
Jenq-Wen Huang
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vascular Calcification ◽  
Estimated Glomerular Filtration Rate ◽  
Bitter Taste ◽  
Uremic Toxin ◽  
Gustatory Function ◽  
Increased Risk ◽  
The Relationship

Patients with chronic kidney disease (CKD) have an increased risk of vascular calcification (VC), including aortic arch calcification (AAC). Few investigated the influence of gustatory function on the probability of having VC. We examined whether gustatory function results modulated the probability of having VC in patients with CKD. We prospectively enrolled adults with CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2), with their AAC rated semi-quantitatively and gustatory function assessed by objective and subjective approaches. Multiple logistic regression was used to analyze the relationship between gustatory function results and AAC. Those with AAC had significantly better objective gustatory function in aggregate scores (p = 0.039) and categories (p = 0.022) and less defective bitter taste (p = 0.045) and scores (p = 0.037) than those without. Multiple regression analyses showed that higher aggregate scores (odds ratio (OR) 1.288, p = 0.032), or better gustatory function, and higher bitter taste scores (OR 2.558, p = 0.019) were each associated with a higher probability of having AAC among CKD patients; such an association was modulated by serum phosphate levels. In conclusion, better gustatory function was independently correlated with having AAC among CKD patients. A follow-up of VC severity may be an underrecognized component of care for CKD patients with a preserved gustatory function.

scholarly journals The important role of primary care physicians in chronic kidney disease follow-up

2016 ◽  
Vol 43 (6) ◽  
pp. 649-656
Author(s):  
Yasuko Okamoto ◽  
Tomoko Ogawa ◽  
Takehiko Baba ◽  
Tetsuya Tajima ◽  
Kunio Yanai ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Primary Care Physicians
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