BACKGROUND: Chronic kidney disease (CKD) is a growing problem among the elderly. Early detection is considered essential to ensure proper treatment and to avoid drug toxicity, but detection is challenging because elderly patients with CKD often have normal serum creatinine levels. We hypothesized that most cases of CKD in the elderly would go undetected, resulting in inappropriate prescribing. OBJECTIVE: To determine whether recognition of CKD is associated with more appropriate treatment DESIGN: Retrospective chart review PARTICIPANTS: All patients aged >/=65 years with a measured serum creatinine in the past 3 years at 2 inner city academic health centers. MEASUREMENTS: Estimated glomerular filtration rate (eGFR) calculated using the Modified Diet in Renal Disease equation, and for patients with eGFR < 60, documentation of CKD by the provider, diagnostic testing, nephrology referral and prescription of appropriate or contraindicated medications. RESULTS: Of 814 patients with sufficient information to estimate eGFR, 192 (33%) had moderate (eGFR < 60 mL/min) and 5% had severe (eGFR < 30 mL/min) CKD. Providers identified 38% of moderate and 87% of severe CKD. Compared to patients without recognized CKD, recognized patients were more likely to receive an ACE/ARB (80% vs 61%, p = .001), a nephrology referral (58% vs 2%, p < .0001), or urine testing (75% vs 47%, p < .0001), and less likely to receive contraindicated medications (26% vs 40%, p = .013). CONCLUSIONS: Physicians frequently fail to diagnose CKD in the elderly, leading to inappropriate treatment. Efforts should focus on helping physicians better identify patients with low GFR.
BACKGROUND:Chronic kidney disease (CKD) is a growing problem among the elderly. Early detection is considered essential to ensure proper treatment and to avoid drug toxicity, but detection is challenging because elderly patients with CKD often have normal serum creatinine levels. We hypothesized that most cases of CKD in the elderly would go undetected, resulting in inappropriate prescribing. OBJECTIVE: To determine whether recognition of CKD is associated with more appropriate treatment DESIGN: Retrospective chart review PARTICIPANTS: All patients aged >/=65 years with a measured serum creatinine in the past 3 years at 2 inner city academic health centers. MEASUREMENTS: Estimated glomerular filtration rate (eGFR) calculated using the Modified Diet in Renal Disease equation, and for patients with eGFR < 60, documentation of CKD by the provider, diagnostic testing, nephrology referral and prescription of appropriate or contraindicated medications. RESULTS: Of 814 patients with sufficient information to estimate eGFR, 192 (33%) had moderate (eGFR < 60 mL/min) and 5% had severe (eGFR < 30 mL/min) CKD. Providers identified 38% of moderate and 87% of severe CKD. Compared to patients without recognized CKD, recognized patients were more likely to receive an ACE/ARB (80% vs 61%, p = .001), a nephrology referral (58% vs 2%, p < .0001), or urine testing (75% vs 47%, p < .0001), and less likely to receive contraindicated medications (26% vs 40%, p = .013). CONCLUSIONS: Physicians frequently fail to diagnose CKD in the elderly, leading to inappropriate treatment. Efforts should focus on helping physicians better identify patients with low GFR.
Authors: Jacobien C Verhave; Pierre Fesler; Jean Ribstein; Guilhem du Cailar; Albert Mimran Journal: Am J Kidney Dis Date: 2005-08 Impact factor: 8.860
Authors: Janice P Lea; William M McClellan; Charlene Melcher; Elisa Gladstone; Tom Hostetter Journal: Am J Kidney Dis Date: 2006-01 Impact factor: 8.860
Authors: Andrew S Levey; Josef Coresh; Tom Greene; Lesley A Stevens; Yaping Lucy Zhang; Stephen Hendriksen; John W Kusek; Frederick Van Lente Journal: Ann Intern Med Date: 2006-08-15 Impact factor: 25.391
Authors: Chester H Fox; Amanda Brooks; Luis E Zayas; William McClellan; Brian Murray Journal: J Am Board Fam Med Date: 2006 Jan-Feb Impact factor: 2.657
Authors: Pankti A Gheewala; Gregory M Peterson; Colin M Curtain; Prasad S Nishtala; Paul J Hannan; Ronald L Castelino Journal: Drugs Aging Date: 2014-11 Impact factor: 3.923
Authors: Krupa Patel; Clarissa Diamantidis; Min Zhan; Van Doren Hsu; Loreen D Walker; James Gardner; Matthew R Weir; Jeffrey C Fink Journal: Am J Nephrol Date: 2012-06-13 Impact factor: 3.754
Authors: Jeffrey C Fink; Jeanine Brown; Van Doren Hsu; Stephen L Seliger; Loreen Walker; Min Zhan Journal: Am J Kidney Dis Date: 2009-02-26 Impact factor: 8.860