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

Background: To explore how CKD stage 3 patients are examined and treated in primary care with emphasis on laboratory analyses. Methods: A total of 386 patients with CKD stage 3, and their physician (one patient per general practitioner (GP)) were selected from hospital laboratory databases. GPs received a questionnaire asking them to categorize their patients' renal function based on creatinine and eGFR results, denoting follow-up and what changes in creatinine and eGFR results were considered clinically important. Results: The response rate was 60%, and 210 patients were included. Patients' median creatinine values were 95 mu mol/L (females) and 124 mu mol/L (males), the median eGFR value was 52 ml/min/1.73 m(2). Only 27% of patients were assessed to have CKD stage 3. 2/3 had either a urine dip strip (59%) and/or a urine albumin measurement (42%) and 20% were diagnosed with albuminuria. Median changes to signal improvement or deterioration in renal function or indicate referral were 14 (12%), 20(18%) and 40 (36%)mu mol/L for creatinine and 8 (17%), 8 (17%) and 13 (26%) ml/min/1.73 m(2) for eGFR. Albuminuria did not influence follow-up strategy. Conclusions: CKD stage 3 patients were insufficiently examined for albuminuria and seemingly referred to hospital care after larger eGFR declines than recommended in guidelines. (C) 2011 Elsevier B.V. All rights reserved.