Barriers to successful care for chronic kidney disease

• Published in: BMC nephrology 2005-10, Vol.6 (1), p.11-11, Article 11
• Main Authors: Lenz, Oliver, Mekala, Durga P, Patel, Daniel V, Fornoni, Alessia, Metz, David, Roth, David
• Format: Article
• Language: English
• Subjects: African Americans; Chronic Disease; Cross-Sectional Studies; Diabetes Complications; Glomerular Filtration Rate; Goals; Guideline Adherence; Humans; Kidney Diseases - ethnology; Kidney Diseases - etiology; Kidney Diseases - physiopathology; Kidney Diseases - therapy; Kidney Failure, Chronic - therapy; Nephrology; Office Visits; Patient Compliance; Practice Guidelines as Topic; Primary Health Care; Referral and Consultation
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/1471-2369-6-11

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. 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. 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. 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.