Barriers to successful care for chronic kidney disease

被引：36

作者：

Lenz O. ^{[1
]}

Mekala D.P. ^{[1
]}

Patel D.V. ^{[1
]}

Fornoni A. ^{[1
]}

Metz D. ^{[1
]}

Roth D. ^{[1
]}

机构：

[1] Division of Nephrology and Hypertension, University of Miami, Miller School of Medicine, Miami, FL

来源：

BMC Nephrology | / 6卷 / 1期

关键词：

Chronic Kidney Disease; Renal Replacement Therapy; Primary Care Provider; Chronic Kidney Disease Patient; Chronic Kidney Disease Stage;

D O I：

10.1186/1471-2369-6-11

中图分类号：

学科分类号：

摘要：

Background: The National Kidney Foundation has formulated clinical practice guidelines for patients with chronic kidney disease (K/DOQI). However, little is know about how many patients actually achieve these goals in a dedicated clinic for chronic kidney disease. Methods: We performed a cross-sectional analysis of 198 patients with an estimated glomerular filtration rate of less than 30 ml/min/1.73 m2 and determined whether K/DOQI goals were met for calcium, phosphate, calcium-phosphate product, parathyroid hormone, albumin, bicarbonate, hemoglobin, lipids, and blood pressure. Results: We found that only a small number of patients achieved K/DOQI targets. Recent referral to the nephrologist, failure to attend scheduled clinic appointments, African American ethnicity, diabetes, and advanced renal failure were significant predictors of low achievement of K/DOQI goals. Conclusion: We conclude that raising awareness of chronic kidney disease and K/DOQI goals among primary care providers, early referral to a nephrologist, the exploration of socioeconomic barriers and cultural differences, and both patient and physician education are critical to improve CKD care in patients with Stage 4 and 5 CKD. © 2005 Lenz et al; licensee BioMed Central Ltd.

引用

共 39 条

[1] Levey A.S., Bosch J.P., Lewis J.B., Greene T., Rogers N., Roth D., A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation, Ann Intern Med, 130, pp. 461-470, (1999)
[2] Foundation N.K., K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification, Am J Kidney Dis, 39, (2002)
[3] Collins A.J., Anaemia management prior to dialysis: Cardiovascular and cost-benefit observations, Nephrol Dial Transplant Suppl, 18, (2003)
[4] Xue J.L., St Peter W.L., Ebben J.P., Everson S.E., Collins A.J., Anemia treatment in the pre-ESRD period and associated mortality in elderly patients, Am J Kidney Dis, 40, pp. 1153-1161, (2002)
[5] Eknoyan G., Levin A., Levin N.W., Foundation N.K., Bone metabolism and disease in chronic kidney disease, Am J Kidney Dis Suppl, 42, pp. 1-201, (2003)
[6] Stevens L.A., Djurdjev O., Cardew S., Cameron E.C., Levin A., Calcium, phosphate, and parathyroid hormone levels in combination and as a function of dialysis duration predict mortality: Evidence for the complexity of the association between mineral metabolism and outcomes, J Am Soc Nephrol, 15, pp. 770-779, (2004)
[7] Eustace J.A., Astor B., Muntner P.M., Ikizler T.A., Coresh J., Prevalence of acidosis and inflammation and their association with low serum albumin in chronic kidney disease, Kidney Int, 65, pp. 1031-1040, (2004)
[8] Locatelli F., Pozzoni P., Tentori F., Del Vecchio L., Epidemiology of cardiovascular risk in patients with chronic kidney disease, Nephrol Dial Transplant Suppl, 18, (2003)
[9] K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease, Am J Kidney Dis Suppl, 43, (2004)
[10] John R., Webb M., Young A., Stevens P.E., Unreferred chronic kidney disease: A longitudinal study, Am J Kidney Dis, 43, pp. 825-835, (2004)

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