Francesco Pesce1, Domenico Pasculli2, Giuseppe Pasculli3,4, Luca De Nicola5, Mario Cozzolino6, Antonio Granata7, Loreto Gesualdo8. 1. Nephrology, Dialysis, and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Piazza Giulio Cesare, 11, 70124, Bari, Italy. francesco.pesce@uniba.it. 2. ASL BA-SIMG Societa' Italiana Medici di Medicina Generale e delle Cure Primarie, Florence, Italy. 3. Nephrology, Dialysis, and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Piazza Giulio Cesare, 11, 70124, Bari, Italy. 4. Department of Computer, Control and Management Engineering Antonio Ruberti (DIAG), La Sapienza University, Rome, Italy. 5. Division of Nephrology, University of Campania "Luigi Vanvitelli", Naples, Italy. 6. Renal Division and Laboratory of Experimental Nephrology, Department of Health Sciences, University of Milan, Milan, Italy. 7. Nephrology and Dialysis Unit, "Cannizzaro" Hospital, 95126, Catania, Italy. 8. Nephrology, Dialysis, and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Piazza Giulio Cesare, 11, 70124, Bari, Italy. loreto.gesualdo@uniba.it.
Abstract
BACKGROUND: The "awareness gap" and the under-recognition of chronic kidney disease (CKD) by general practitioners (GPs) is well documented. We set a framework to evaluate the impact in primary care of targeted training and networking with nephrologists with regard to CKD awareness in terms of potential increase of the proportion of patients classified according to KDIGO in the general population and in patients with diabetes, hypertension and heart failure. METHODS: Data were extracted from the Millewin Digital Platform in use by the GPs (N = 17) at baseline (T0, N = 17,854) and after 6 months (T6, N = 18,662) of networking (education, instant messaging and selected joint visits) with nephrologists (N = 2). The following variables were extracted: age, sex, eGFR (estimated glomerular filtration rate), ACR (urinary albumin-to-creatinine ratio), presence of type 2 diabetes, hypertension and heart failure. The proportion of patients detected having an eGFR below 60 mL/min/1.73m2 was also reported as deemed clinically relevant. RESULTS: We observed an increase in the use of ACR and eGFR tests in the entire cohort (+ 121% and + 73%, respectively) and in patients with comorbidities. The proportion of patients with eGFR < 60 mL/min/1.73m2 significantly increased from 2.2% to 3.8% in the entire cohort, from 6.3% to 12.7% in patients with diabetes, and from 5.6% to 9.9% in those with hypertension and finally from 10.8% to 23.7% in patients with heart failure. CONCLUSIONS: Training and network support to GPs by nephrologists can improve CKD awareness and increase its identification in the general population and, even more, in categories at risk.
BACKGROUND: The "awareness gap" and the under-recognition of chronic kidney disease (CKD) by general practitioners (GPs) is well documented. We set a framework to evaluate the impact in primary care of targeted training and networking with nephrologists with regard to CKD awareness in terms of potential increase of the proportion of patients classified according to KDIGO in the general population and in patients with diabetes, hypertension and heart failure. METHODS: Data were extracted from the Millewin Digital Platform in use by the GPs (N = 17) at baseline (T0, N = 17,854) and after 6 months (T6, N = 18,662) of networking (education, instant messaging and selected joint visits) with nephrologists (N = 2). The following variables were extracted: age, sex, eGFR (estimated glomerular filtration rate), ACR (urinary albumin-to-creatinine ratio), presence of type 2 diabetes, hypertension and heart failure. The proportion of patients detected having an eGFR below 60 mL/min/1.73m2 was also reported as deemed clinically relevant. RESULTS: We observed an increase in the use of ACR and eGFR tests in the entire cohort (+ 121% and + 73%, respectively) and in patients with comorbidities. The proportion of patients with eGFR < 60 mL/min/1.73m2 significantly increased from 2.2% to 3.8% in the entire cohort, from 6.3% to 12.7% in patients with diabetes, and from 5.6% to 9.9% in those with hypertension and finally from 10.8% to 23.7% in patients with heart failure. CONCLUSIONS: Training and network support to GPs by nephrologists can improve CKD awareness and increase its identification in the general population and, even more, in categories at risk.
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Authors: Michael G Shlipak; Sri Lekha Tummalapalli; L Ebony Boulware; Morgan E Grams; Joachim H Ix; Vivekanand Jha; Andre-Pascal Kengne; Magdalena Madero; Borislava Mihaylova; Navdeep Tangri; Michael Cheung; Michel Jadoul; Wolfgang C Winkelmayer; Sophia Zoungas Journal: Kidney Int Date: 2020-10-27 Impact factor: 10.612