Monday, December 23, 2013

Missing the diagnosis of CKD

The good folks at the Oregon Rural Practice Based Research Network looked through their database of lab results and found 865 patients with laboratory evidence of chronic kidney disease (CKD). Of these, 52% had no documentation of the diagnosis in the chart. CKD in women was missed more often than in men. Importantly, the care of high blood pressure was better in those CKD patients where the provider had documented the diagnosis.
What's going on? Is this just a documentation issue?  Probably not. We've seen the same phenomenon in several other clinical settings. It's related to the difficulty of interpreting serum creatinine levels, the complexity and relative newness of the diagnostic criteria for CKD, the permanent brain cramp for all things kidney that medical school renal physiology courses induce, and the presence of the creatinine test in larger panels that are used when kidney disease is not top of mind. So, like the Oregonians, we also found that the number of known CKD cases goes up by 80-100% when the creatinine is systematically looked at (in the form of the estimated GFR value).
You can't engage patients in the care of their kidney problems and prevent end-stage renal disease if you don't even recognize that the patient has kidney disease in the first place! Happily, there are systems to help, and they are effective, easy and inexpensive. Let me know if you want to know more.

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