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Clinical Nephrology
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Opportunities for Improving the Care of Patients with Chronic Renal Insufficiency: Current Practice Patterns

ALLEN R. NISSENSON, ALLAN J. COLLINS, JUDITH HURLEY, HANS PETERSEN, BRIAN J. G. PEREIRA and EARL P. STEINBERG
JASN August 2001, 12 (8) 1713-1720;
ALLEN R. NISSENSON
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ALLAN J. COLLINS
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JUDITH HURLEY
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HANS PETERSEN
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BRIAN J. G. PEREIRA
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EARL P. STEINBERG
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Abstract

Abstract. There are between 2 and 13 million Americans with chronic kidney disease (CKD). Recent reports suggest that their treatment is currently suboptimal. To further investigate this issue, patterns of practice for the treatment of patients with CKD who were enrolled in a large health maintenance organization in New Mexico were analyzed. Among the >200,000 patients who were enrolled in the health maintenance organization between 1994 and 1997, a cohort of 1658 patients who exhibited at least two gender-specific, elevated creatinine concentrations (Cr), separated by at least 90 d, were identified. The proportions of patients with Cr values of <2.0, 2.0 to 2.9, 3.0 to 3.9, and ≥4.0 mg/dl were 73, 17, 3, and 7%, respectively. The majority of patients were treated by a primary care physician until Cr values reached 3.0 mg/dl, at which time a nephrologist was consulted. Care tended to be transferred to the nephrologist when the Cr reached 4.0 mg/dl. Only 7.4% of patients received erythropoietin (EPO). Use of EPO increased as Cr increased. EPO was unlikely to be prescribed unless the patient had visited a nephrologist. Fewer than one half of all patients with CKD and fewer than 20% of patients with CKD with Cr values of ≥4.0 mg/dl received an angiotensin-converting enzyme inhibitor (ACEI). Nephrologists were not more likely to prescribe ACEI than were primary care physicians. Diabetic patients were more likely to receive ACEI than were nondiabetic patients, but ACEI use was quite low even among diabetic patients with CKD. The average number of hospitalizations per patient-year increased as Cr increased and was more than twice as high for patients with Cr values of ≥4.0 mg/dl, compared with those with Cr values of <2.0 mg/dl. The reasons for hospitalization were more likely to be related to comorbidities than to CKD itself, however. There are many opportunities to improve the care of patients with CKD. Better adherence to practices known to be of clinical benefit for patients with CKD not only will improve patient outcomes but also may reduce the costs of care. Providers, policy-makers, and payers should view CKD as a major public health problem and initiate innovative programs to address this growing patient population.

  • © 2001 American Society of Nephrology
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Journal of the American Society of Nephrology: 12 (8)
Journal of the American Society of Nephrology
Vol. 12, Issue 8
1 Aug 2001
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Opportunities for Improving the Care of Patients with Chronic Renal Insufficiency: Current Practice Patterns
ALLEN R. NISSENSON, ALLAN J. COLLINS, JUDITH HURLEY, HANS PETERSEN, BRIAN J. G. PEREIRA, EARL P. STEINBERG
JASN Aug 2001, 12 (8) 1713-1720;

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Opportunities for Improving the Care of Patients with Chronic Renal Insufficiency: Current Practice Patterns
ALLEN R. NISSENSON, ALLAN J. COLLINS, JUDITH HURLEY, HANS PETERSEN, BRIAN J. G. PEREIRA, EARL P. STEINBERG
JASN Aug 2001, 12 (8) 1713-1720;
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More in this TOC Section

  • A Randomized, Controlled Trial of Steroids and Cyclophosphamide in Adults with Nephrotic Syndrome Caused by Idiopathic Membranous Nephropathy
  • Lower Progression Rate of End-Stage Renal Disease in Patients with Peripheral Arterial Disease Using Statins or Angiotensin-Converting Enzyme Inhibitors
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Cited By...

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  • A Nurse-coordinated Model of Care versus Usual Care for Stage 3/4 Chronic Kidney Disease in the Community: A Randomized Controlled Trial
  • Multidisciplinary Team Care May Slow the Rate of Decline in Renal Function
  • Recommendations for a Clinical Decision Support for the Management of Individuals with Chronic Kidney Disease
  • Perception of Indications for Nephrology Referral among Internal Medicine Residents: A National Online Survey
  • Association between Multidisciplinary Care and Survival for Elderly Patients with Chronic Kidney Disease
  • Advanced Chronic Kidney Disease Practice Patterns among Nephrologists and Non-Nephrologists: A Database Analysis
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  • General Medical Care among Patients with Chronic Kidney Disease: Opportunities for Improving Outcomes
  • Identifying Individuals with a Reduced GFR Using Ambulatory Laboratory Database Surveillance
  • Traditional and Nontraditional Risk Factors Predict Coronary Heart Disease in Chronic Kidney Disease: Results from the Atherosclerosis Risk in Communities Study
  • Projecting future drug expenditures--2005
  • Cost of Medical Care for Chronic Kidney Disease and Comorbidity among Enrollees in a Large HMO Population
  • Iron Status and Hemoglobin Level in Chronic Renal Insufficiency
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