Management of advanced chronic kidney disease in primary care - current data from Germany.

The quality of chronic kidney disease (CKD) care and the control of CKD progression factors and of comorbid conditions according to current recommendations in primary care were investigated in this retrospective cohort study of 127 consecutive CKD patients. CKD was advanced (glomerular filtration rate 21 +/- 10 ml/min). Fifty-seven per cent of patients had been evaluated to clarify CKD aetiology. Blood pressure was substantially elevated (148 +/- 20/83 +/- 11 mmHg) and only 39% of patients achieved target blood pressure levels. At a mean HbA(1c) of 6.5 +/- 1.1%, glycaemic control was good in 63% of diabetics. Mean haemoglobin was 10.8 +/- 1.8 g/dl, and anaemia was adequately controlled in 49%. In 42% the management of bone disease and in 80% the nutritional status was sufficient. Angiotensin converting enzyme inhibitors or angiotensin-2-receptor blockers was used in 59% of patients with diabetic nephropathy or proteinuria above 1 g/day. High-total quality of care was only achieved in 35% which suggests that the management of advanced CKD in primary care is suboptimal.