Results of a national study of 304 U.S. physicians, in which "mock" patients' symptoms were presented for diagnosis, suggest that a sizeable percentage of primary care doctors probably fail to properly diagnose and refer patients with chronic kidney disease (CKD).
Their findings, reported in the August issue of the American Journal of Kidney Diseases, show that of 126 kidney specialists surveyed, 97 percent properly diagnosed CKD and 99 percent would have recommended specialized kidney care for the "patient." But only 59 percent of the 89 family physicians and 78 percent of 89 general internal medicine physicians fully recognized the signs and symptoms of CKD. And referrals to a nephrologist were made by only 76 percent of the family physicians and only 81 percent of general internists.
"We, as physicians, can certainly do better," says L. Ebony Boulware, M.D., Assistant Professor of Medicine at The Johns Hopkins University School of Medicine, and lead author of the study.
"Millions of people have kidney disease, but a substantial number may not have their disease recognized," Boulware added. "Simply put, our study shows that primary care physicians are not recognizing kidney disease in high-risk patients as often as they should."
In the study, the Hopkins group asked the surveyed physicians to evaluate the medical files of a simulated patient being treated by a primary-care doctor and suffering from progressive CKD. CKD is a growing epidemic, affecting an estimated 10 million Americans. The medical "record" contained clues to the condition indicating that, based on guidelines issued in 2000 by the National Kidney Foundation, the patient should be referred to a nephrologist for evaluation of CKD.
CKD is characterized by the progressive loss of renal function over a period of months or years. Signs include an abnormally low glomerular filtration rate, a standard measurement of renal health. The severe form of the disease, known as end-stage renal disease, or ESRD, almost always requires dialysis, or kidney transplantation.
Boulware and her colleagues say early detection of CKD is especially critical given that previous studies indicate that, for many high-risk patients, the progression of kidney disease can be markedly slowed if physicians prescribe appropriate therapies including blood pressure medications such as angiotensin converting enzyme-inhibitors or angiotensin-II receptor blocking agents.
Patients with hypertension, diabetes, or a family history of kidney disease are at increased risk of kidney disease.