Loading…
Albuminuria testing and nephrology care among insured US adults with chronic kidney disease: a missed opportunity
In chronic kidney disease (CKD), assessment of both estimated glomerular filtration rate (eGFR) and albuminuria are necessary for stratifying risk and determining the need for nephrology referral. The Kidney Disease: Improving Global Outcomes clinical practice guidelines for CKD recommend nephrology...
Saved in:
| Published in: | BMC family practice 2022-11, Vol.23 (1), p.299-299, Article 299 |
|---|---|
| Main Authors: | , , , , , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that this one cites Items that cite this one |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | cdi_FETCH-LOGICAL-c563t-82aa4ffdee71236e24c717559d59b02071573ae4056f62e6a18e4963a92cfb0e3 |
|---|---|
| cites | cdi_FETCH-LOGICAL-c563t-82aa4ffdee71236e24c717559d59b02071573ae4056f62e6a18e4963a92cfb0e3 |
| container_end_page | 299 |
| container_issue | 1 |
| container_start_page | 299 |
| container_title | BMC family practice |
| container_volume | 23 |
| creator | Chu, Chi D Powe, Neil R Shlipak, Michael G Scherzer, Rebecca Tummalapalli, Sri Lekha Estrella, Michelle M Tuot, Delphine S |
| description | In chronic kidney disease (CKD), assessment of both estimated glomerular filtration rate (eGFR) and albuminuria are necessary for stratifying risk and determining the need for nephrology referral. The Kidney Disease: Improving Global Outcomes clinical practice guidelines for CKD recommend nephrology referral for eGFR |
| doi_str_mv | 10.1186/s12875-022-01910-9 |
| format | article |
| fullrecord | <record><control><sourceid>gale_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_a2a5bb2d2e414dd1af807630300615a4</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A727944344</galeid><doaj_id>oai_doaj_org_article_a2a5bb2d2e414dd1af807630300615a4</doaj_id><sourcerecordid>A727944344</sourcerecordid><originalsourceid>FETCH-LOGICAL-c563t-82aa4ffdee71236e24c717559d59b02071573ae4056f62e6a18e4963a92cfb0e3</originalsourceid><addsrcrecordid>eNptUk1vEzEUXCEQrUr_AAdkiQuXLf52zAEpqvioVIkD9Gy9tb2Jw66d2rtF-fc4TSkNQj7Yem9mnt54muY1wReELOT7QuhCiRZT2mKiCW71s-aUKkZaLgR7_uR90pyXssEYUyUVZexlc8IkZ1wQdtrcLoduHkOccwA0-TKFuEIQHYp-u85pSKsdspA9gjHVTohlzt6hm-8I3DxMBf0K0xrZCo3Bop_BRb9DLhQPxX9AgMZQSsWn7TblaY5h2r1qXvQwFH_-cJ81N58__bj82l5_-3J1ubxurZBsahcUgPe9814RyqSn3CqihNBO6A5TrIhQDDzHQvaSeglk4bmWDDS1fYc9O2uuDrouwcZscxgh70yCYO4LKa8M5CnYwRugILqOOuo54c4R6BdYSYYZxpII4FXr40FrO3ejd9bHKcNwJHrciWFtVunOaIWxFnuBdw8COd3O1WZTjbF-GCD6NBdDVV0Ea65Vhb79B7pJc47VqooSQpIKZH9RK6gLhNinOtfuRc1SUaV5_eD92Iv_oOpxfgw2Rd-HWj8i0APB5lRK9v3jjgSbfe7MIXem5s7c587oSnrz1J1Hyp-Usd_F_9Jn</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2755610503</pqid></control><display><type>article</type><title>Albuminuria testing and nephrology care among insured US adults with chronic kidney disease: a missed opportunity</title><source>Publicly Available Content Database</source><source>PubMed Central</source><creator>Chu, Chi D ; Powe, Neil R ; Shlipak, Michael G ; Scherzer, Rebecca ; Tummalapalli, Sri Lekha ; Estrella, Michelle M ; Tuot, Delphine S</creator><creatorcontrib>Chu, Chi D ; Powe, Neil R ; Shlipak, Michael G ; Scherzer, Rebecca ; Tummalapalli, Sri Lekha ; Estrella, Michelle M ; Tuot, Delphine S</creatorcontrib><description>In chronic kidney disease (CKD), assessment of both estimated glomerular filtration rate (eGFR) and albuminuria are necessary for stratifying risk and determining the need for nephrology referral. The Kidney Disease: Improving Global Outcomes clinical practice guidelines for CKD recommend nephrology referral for eGFR < 30 ml/min/1.73m
or for urinary albumin/creatinine ratio ≥ 300 mg/g.
Using a national claims database of US patients covered by commercial insurance or Medicare Advantage, we identified patients with CKD who were actively followed in primary care. We examined receipt of nephrology care within 1 year among these patients according to their stage of CKD, classified using eGFR and albuminuria categories. Multivariable logistic regression was used to examine odds of receiving nephrology care by CKD category, adjusting for age, sex, race/ethnicity, diabetes, heart failure, and coronary artery disease.
Among 291,155 patients with CKD, 55% who met guideline-recommended referral criteria had seen a nephrologist. Receipt of guideline-recommended nephrology care was higher among those with eGFR < 30 (64%; 11,330/17738) compared with UACR ≥300 mg/g (51%; 8789/17290). 59% did not have albuminuria testing. Those patients without albuminuria testing had substantially lower adjusted odds of recommended nephrology care (aOR 0.47 [0.43, 0.52] for eGFR < 30 ml/min/1.73m
). Similar patterns were observed in analyses stratified by diabetes status.
Only half of patients meeting laboratory criteria for nephrology referral were seen by a nephrologist. Underutilization of albuminuria testing may be a barrier to identifying primary care patients at elevated kidney failure risk who may warrant nephrology referral.</description><identifier>ISSN: 2731-4553</identifier><identifier>EISSN: 2731-4553</identifier><identifier>EISSN: 1471-2296</identifier><identifier>DOI: 10.1186/s12875-022-01910-9</identifier><identifier>PMID: 36434513</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adult ; Aged ; Albuminuria ; Albuminuria - diagnosis ; Cardiovascular disease ; Chronic kidney disease ; Chronic kidney failure ; Clinical medicine ; Clinical practice guidelines ; Complications and side effects ; Creatinine ; Diabetes ; Diagnosis ; Glomerular Filtration Rate ; Health care access ; Hemodialysis ; Humans ; Hypertension ; Kidney diseases ; Laboratories ; Medical care ; Medical referrals ; Medicare ; Nephrology ; Nephrology referral ; Primary care ; Renal Insufficiency, Chronic - diagnosis ; Risk factors ; United States - epidemiology ; Utilization</subject><ispartof>BMC family practice, 2022-11, Vol.23 (1), p.299-299, Article 299</ispartof><rights>2022. The Author(s).</rights><rights>COPYRIGHT 2022 BioMed Central Ltd.</rights><rights>2022. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c563t-82aa4ffdee71236e24c717559d59b02071573ae4056f62e6a18e4963a92cfb0e3</citedby><cites>FETCH-LOGICAL-c563t-82aa4ffdee71236e24c717559d59b02071573ae4056f62e6a18e4963a92cfb0e3</cites><orcidid>0000-0002-6069-1507</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9700954/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9700954/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,36990,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36434513$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chu, Chi D</creatorcontrib><creatorcontrib>Powe, Neil R</creatorcontrib><creatorcontrib>Shlipak, Michael G</creatorcontrib><creatorcontrib>Scherzer, Rebecca</creatorcontrib><creatorcontrib>Tummalapalli, Sri Lekha</creatorcontrib><creatorcontrib>Estrella, Michelle M</creatorcontrib><creatorcontrib>Tuot, Delphine S</creatorcontrib><title>Albuminuria testing and nephrology care among insured US adults with chronic kidney disease: a missed opportunity</title><title>BMC family practice</title><addtitle>BMC Prim Care</addtitle><description>In chronic kidney disease (CKD), assessment of both estimated glomerular filtration rate (eGFR) and albuminuria are necessary for stratifying risk and determining the need for nephrology referral. The Kidney Disease: Improving Global Outcomes clinical practice guidelines for CKD recommend nephrology referral for eGFR < 30 ml/min/1.73m
or for urinary albumin/creatinine ratio ≥ 300 mg/g.
Using a national claims database of US patients covered by commercial insurance or Medicare Advantage, we identified patients with CKD who were actively followed in primary care. We examined receipt of nephrology care within 1 year among these patients according to their stage of CKD, classified using eGFR and albuminuria categories. Multivariable logistic regression was used to examine odds of receiving nephrology care by CKD category, adjusting for age, sex, race/ethnicity, diabetes, heart failure, and coronary artery disease.
Among 291,155 patients with CKD, 55% who met guideline-recommended referral criteria had seen a nephrologist. Receipt of guideline-recommended nephrology care was higher among those with eGFR < 30 (64%; 11,330/17738) compared with UACR ≥300 mg/g (51%; 8789/17290). 59% did not have albuminuria testing. Those patients without albuminuria testing had substantially lower adjusted odds of recommended nephrology care (aOR 0.47 [0.43, 0.52] for eGFR < 30 ml/min/1.73m
). Similar patterns were observed in analyses stratified by diabetes status.
Only half of patients meeting laboratory criteria for nephrology referral were seen by a nephrologist. Underutilization of albuminuria testing may be a barrier to identifying primary care patients at elevated kidney failure risk who may warrant nephrology referral.</description><subject>Adult</subject><subject>Aged</subject><subject>Albuminuria</subject><subject>Albuminuria - diagnosis</subject><subject>Cardiovascular disease</subject><subject>Chronic kidney disease</subject><subject>Chronic kidney failure</subject><subject>Clinical medicine</subject><subject>Clinical practice guidelines</subject><subject>Complications and side effects</subject><subject>Creatinine</subject><subject>Diabetes</subject><subject>Diagnosis</subject><subject>Glomerular Filtration Rate</subject><subject>Health care access</subject><subject>Hemodialysis</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Kidney diseases</subject><subject>Laboratories</subject><subject>Medical care</subject><subject>Medical referrals</subject><subject>Medicare</subject><subject>Nephrology</subject><subject>Nephrology referral</subject><subject>Primary care</subject><subject>Renal Insufficiency, Chronic - diagnosis</subject><subject>Risk factors</subject><subject>United States - epidemiology</subject><subject>Utilization</subject><issn>2731-4553</issn><issn>2731-4553</issn><issn>1471-2296</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptUk1vEzEUXCEQrUr_AAdkiQuXLf52zAEpqvioVIkD9Gy9tb2Jw66d2rtF-fc4TSkNQj7Yem9mnt54muY1wReELOT7QuhCiRZT2mKiCW71s-aUKkZaLgR7_uR90pyXssEYUyUVZexlc8IkZ1wQdtrcLoduHkOccwA0-TKFuEIQHYp-u85pSKsdspA9gjHVTohlzt6hm-8I3DxMBf0K0xrZCo3Bop_BRb9DLhQPxX9AgMZQSsWn7TblaY5h2r1qXvQwFH_-cJ81N58__bj82l5_-3J1ubxurZBsahcUgPe9814RyqSn3CqihNBO6A5TrIhQDDzHQvaSeglk4bmWDDS1fYc9O2uuDrouwcZscxgh70yCYO4LKa8M5CnYwRugILqOOuo54c4R6BdYSYYZxpII4FXr40FrO3ejd9bHKcNwJHrciWFtVunOaIWxFnuBdw8COd3O1WZTjbF-GCD6NBdDVV0Ea65Vhb79B7pJc47VqooSQpIKZH9RK6gLhNinOtfuRc1SUaV5_eD92Iv_oOpxfgw2Rd-HWj8i0APB5lRK9v3jjgSbfe7MIXem5s7c587oSnrz1J1Hyp-Usd_F_9Jn</recordid><startdate>20221124</startdate><enddate>20221124</enddate><creator>Chu, Chi D</creator><creator>Powe, Neil R</creator><creator>Shlipak, Michael G</creator><creator>Scherzer, Rebecca</creator><creator>Tummalapalli, Sri Lekha</creator><creator>Estrella, Michelle M</creator><creator>Tuot, Delphine S</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-6069-1507</orcidid></search><sort><creationdate>20221124</creationdate><title>Albuminuria testing and nephrology care among insured US adults with chronic kidney disease: a missed opportunity</title><author>Chu, Chi D ; Powe, Neil R ; Shlipak, Michael G ; Scherzer, Rebecca ; Tummalapalli, Sri Lekha ; Estrella, Michelle M ; Tuot, Delphine S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c563t-82aa4ffdee71236e24c717559d59b02071573ae4056f62e6a18e4963a92cfb0e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Albuminuria</topic><topic>Albuminuria - diagnosis</topic><topic>Cardiovascular disease</topic><topic>Chronic kidney disease</topic><topic>Chronic kidney failure</topic><topic>Clinical medicine</topic><topic>Clinical practice guidelines</topic><topic>Complications and side effects</topic><topic>Creatinine</topic><topic>Diabetes</topic><topic>Diagnosis</topic><topic>Glomerular Filtration Rate</topic><topic>Health care access</topic><topic>Hemodialysis</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Kidney diseases</topic><topic>Laboratories</topic><topic>Medical care</topic><topic>Medical referrals</topic><topic>Medicare</topic><topic>Nephrology</topic><topic>Nephrology referral</topic><topic>Primary care</topic><topic>Renal Insufficiency, Chronic - diagnosis</topic><topic>Risk factors</topic><topic>United States - epidemiology</topic><topic>Utilization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chu, Chi D</creatorcontrib><creatorcontrib>Powe, Neil R</creatorcontrib><creatorcontrib>Shlipak, Michael G</creatorcontrib><creatorcontrib>Scherzer, Rebecca</creatorcontrib><creatorcontrib>Tummalapalli, Sri Lekha</creatorcontrib><creatorcontrib>Estrella, Michelle M</creatorcontrib><creatorcontrib>Tuot, Delphine S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>BMC family practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chu, Chi D</au><au>Powe, Neil R</au><au>Shlipak, Michael G</au><au>Scherzer, Rebecca</au><au>Tummalapalli, Sri Lekha</au><au>Estrella, Michelle M</au><au>Tuot, Delphine S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Albuminuria testing and nephrology care among insured US adults with chronic kidney disease: a missed opportunity</atitle><jtitle>BMC family practice</jtitle><addtitle>BMC Prim Care</addtitle><date>2022-11-24</date><risdate>2022</risdate><volume>23</volume><issue>1</issue><spage>299</spage><epage>299</epage><pages>299-299</pages><artnum>299</artnum><issn>2731-4553</issn><eissn>2731-4553</eissn><eissn>1471-2296</eissn><abstract>In chronic kidney disease (CKD), assessment of both estimated glomerular filtration rate (eGFR) and albuminuria are necessary for stratifying risk and determining the need for nephrology referral. The Kidney Disease: Improving Global Outcomes clinical practice guidelines for CKD recommend nephrology referral for eGFR < 30 ml/min/1.73m
or for urinary albumin/creatinine ratio ≥ 300 mg/g.
Using a national claims database of US patients covered by commercial insurance or Medicare Advantage, we identified patients with CKD who were actively followed in primary care. We examined receipt of nephrology care within 1 year among these patients according to their stage of CKD, classified using eGFR and albuminuria categories. Multivariable logistic regression was used to examine odds of receiving nephrology care by CKD category, adjusting for age, sex, race/ethnicity, diabetes, heart failure, and coronary artery disease.
Among 291,155 patients with CKD, 55% who met guideline-recommended referral criteria had seen a nephrologist. Receipt of guideline-recommended nephrology care was higher among those with eGFR < 30 (64%; 11,330/17738) compared with UACR ≥300 mg/g (51%; 8789/17290). 59% did not have albuminuria testing. Those patients without albuminuria testing had substantially lower adjusted odds of recommended nephrology care (aOR 0.47 [0.43, 0.52] for eGFR < 30 ml/min/1.73m
). Similar patterns were observed in analyses stratified by diabetes status.
Only half of patients meeting laboratory criteria for nephrology referral were seen by a nephrologist. Underutilization of albuminuria testing may be a barrier to identifying primary care patients at elevated kidney failure risk who may warrant nephrology referral.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>36434513</pmid><doi>10.1186/s12875-022-01910-9</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-6069-1507</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2731-4553 |
| ispartof | BMC family practice, 2022-11, Vol.23 (1), p.299-299, Article 299 |
| issn | 2731-4553 2731-4553 1471-2296 |
| language | eng |
| recordid | cdi_doaj_primary_oai_doaj_org_article_a2a5bb2d2e414dd1af807630300615a4 |
| source | Publicly Available Content Database; PubMed Central |
| subjects | Adult Aged Albuminuria Albuminuria - diagnosis Cardiovascular disease Chronic kidney disease Chronic kidney failure Clinical medicine Clinical practice guidelines Complications and side effects Creatinine Diabetes Diagnosis Glomerular Filtration Rate Health care access Hemodialysis Humans Hypertension Kidney diseases Laboratories Medical care Medical referrals Medicare Nephrology Nephrology referral Primary care Renal Insufficiency, Chronic - diagnosis Risk factors United States - epidemiology Utilization |
| title | Albuminuria testing and nephrology care among insured US adults with chronic kidney disease: a missed opportunity |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-08T07%3A52%3A23IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Albuminuria%20testing%20and%20nephrology%20care%20among%20insured%20US%20adults%20with%20chronic%20kidney%20disease:%20a%20missed%20opportunity&rft.jtitle=BMC%20family%20practice&rft.au=Chu,%20Chi%20D&rft.date=2022-11-24&rft.volume=23&rft.issue=1&rft.spage=299&rft.epage=299&rft.pages=299-299&rft.artnum=299&rft.issn=2731-4553&rft.eissn=2731-4553&rft_id=info:doi/10.1186/s12875-022-01910-9&rft_dat=%3Cgale_doaj_%3EA727944344%3C/gale_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c563t-82aa4ffdee71236e24c717559d59b02071573ae4056f62e6a18e4963a92cfb0e3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2755610503&rft_id=info:pmid/36434513&rft_galeid=A727944344&rfr_iscdi=true |