Primary Care Physicians’ Knowledge and Practice Patterns in the Treatment of Chronic Kidney Disease: An Upstate New York Practice-based Research Network (UNYNET) Study

Chester H. Fox; Amanda Brooks; Luis E. Zayas; William McClellan; Brian Murray

doi:10.3122/jabfm.19.1.54

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Figure 1.
Practice sites in the 8 counties where the interviews were conducted.

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Table 1.

Physician Practice Patterns Related to the Key Points of the K/DOQI Guidelines29,30

Guideline	Qualitative Interview (n = 10)	Quantitative Exit Survey (n = 10)
Use of GFR to diagnose CKD	1	N/A
Check for microalbumin	N/A	9
Control BP to <130/80	10	10
Use ACE/ARB early	8	N/A
Treat cholesterol	N/A	8
HDL >40
LDL <100
Use erythropoietin for anemia	2	N/A
Keep hemoglobin >11	1	1
Check calcium, phosphorous, and PTH for bone disease	2	8
Refer to nephrologist for GFR <30	0	N/A

K/DOQI, Kidney Disease Outcomes Quality Initiative; GFR, glomerular filtration rate; CKD, chronic kidney disease; BP, blood pressure; ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; HDL, high-density lipoprotein; LDL, low-density lipoprotein; PTH, parathyroid hormone.

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Table 2.

Key Points to Improve Diagnosis and Treatment of Chronic Kidney Disease26,27,28

• Estimated GFR is more accurate than serum creatinine in the diagnosis of CKD.

• A GFR of <60 puts a patient at risk for the complications of CKD, which are coronary artery disease, anemia, and bone loss due to secondary hyperparathyroidism.

• When the GFR falls below 60, stop metformin and all nonsteroidals and COX-2 inhibitors.

• Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers slow the progression of CKD.

• CKD is a coronary artery disease equivalent; therefore, lipid goals should be LDL <100 and HDL >40.

• If the hemoglobin is <11 due to CKD, then erythropoietin replacement will reduce mortality, delay progression to dialysis, and improve quality of life.

• Checking calcium, phosphorous, and PTH will help secondary hyperparathyroidism. Treatment to keep the calcium phosphate product below 55 and keeping the PTH as close to normal as possible will help prevent bone loss and delay the progression of the disease.