Physicians Pay Attention: You Aren't Testing Your Patients Adequately for Kidney

[okarol]

Physicians Pay Attention: You Aren't Testing Your Patients Adequately for Kidney Disease!

Herman Hurwitz, MD, FCAP

Medscape J Med.  2008;10(3):66.  ©2008 Medscape
Posted 03/17/2008

Chronic kidney disease, or CKD, is a life-threatening condition that affects more than 1 in 9 adults in the United States.[1] The consequences of inadequately treated CKD are cardiovascular disease and its comorbidities -- heart attack and stroke -- as well as renal failure. A recent Quest Diagnostics Health Trends Report suggests that patients most at risk for CKD -- specifically, those with diabetes or hypertension[2] -- are not being effectively monitored.

Monitoring at-risk patients is essential because CKD is usually silent until its late less treatable stages.[3] Yet, many physicians apparently are not providing simple interventions, which can slow or halt disease progression.[4] These include careful monitoring of A1C, reducing LDL cholesterol, and prescribing angiotensin-converting enzyme inhibitors or receptor blockers for nephropathy as well as hypertension.

Our analysis, developed in partnership with the National Kidney Foundation, found that a stunning 60% of patients with diabetes and kidney disease did not receive a test for urine microalbumin during a 12-month period. Ninety percent of patients who had hypertension and kidney disease also did not receive the test. Urine tests for microalbumin, a biological marker for renal vascular damage, are available through most laboratories. This test should be performed at least annually for these patients, according to guidelines from the National Kidney Foundation, the American Diabetes Association, the National Institutes of Health, and the National Heart, Lung, and Blood Institute.[5-8]

Our report, based on results of 5.2 million patients in the Quest Diagnostics database, is a resounding alarm to the medical community that they need to do a better job of monitoring for this insidious disease. With increased physician awareness and improved monitoring, patients with CKD will be able to receive treatments that can slow disease progression, while those at risk for CKD will stand a better chance of having their disease detected in its early, most treatable stages.

That's my opinion. I'm Dr. Herman Hurwitz, Senior Medical Director, Quest Diagnostics Mid Atlantic business unit-Philadelphia Campus.

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References

   1. National Kidney Foundation. Chronic kidney disease. The facts about kidney disease. 2007. Available at: http://www.kidney.org/kidneydisease
      /ckd/index.cfm#facts Accessed March 11, 2008.
   2. National Kidney Foundation. Chronic kidney disease. What causes CKD? 2007. Available at: http://www.kidney.org/kidneydisease/ckd/index.cfm#what Accessed March 11, 2008.
   3. Kinchen KS, Sadler J, Fink N, et al. The timing of specialist evaluation in chronic kidney disease and mortality. Ann Intern Med. 2002;137:479-486. Available at: http://www.annals.org/cgi/content/summary/
      137/6/479 Accessed March 11, 2008.
   4. Mann JF, Gerstein HC, Yi QL, et al. Development of renal disease in people at high cardiovascular risk: results of the HOPE randomized study. J Am Soc Nephrol. 2003;14:641-647. Available at: http://www.hdcn.com/03
      /003jama.htm Accessed March 11, 2008.
   5. National Kidney Foundation. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis. 2007;49 (suppl2):S1-S180. Available at: http://www.kidney.org/professionals/kdoqi/guideline_diabetes
      /pdf/Diabetes_AJKD_linked.pdf Accessed March 11, 2008.
   6. National Heart, Lung, and Blood Institute. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. NIH Publication No. 04-5230. August 2004. Available at: http://www.nhlbi.nih.gov/guidelines/hypertension
      /jnc7full.pdf Accessed March 11, 2008.
   7. National Kidney Disease Education Program. Kidney Disease: Simple Testing. NIH Publication No. 06-5350. August 2006. Available at: http://www.nkdep.nih.gov/resources
      /chronic_kidney_disease_reference_508.pdf Accessed March 11, 2008.
   8. Standards of Medical Care in Diabetes -- 2007. American Diabetes Association. Diabetes Care. 2007;30(suppl1). Available at: http://care.diabetesjournals.org/cgi/content
      /extract/30/suppl_1/S4 Accessed March 11, 2008.


Herman Hurwitz, MD, FCAP, Senior Medical Director, Quest Diagnostics, Mid Atlantic BU Philadelphia Campus, Horsham, Pennsylvania
Author's email: herman.s.hurwitz@questdiagnostics.com

Disclosure: Herman Hurwitz, MD, FCAP, has disclosed no relevant financial relationships in addition to his employment.

http://www.medscape.com/viewarticle/570695

[carla]

My current Nephrologist told me that if I had started doing the things I am doing now two years ago I could have halted the progression of my renal disease.  Well I went to a Nephrologist 2 years ago when my Creatinine was 2.0 and I was told there was nothing that could be done until my kidneys failed and then I would be put on dialysis.  That nephrologist did not mention anemia, phosphate binders, taking more than one  bp medication, electrolytes or anything.  This was a Nephrologist too.  If the Nephrologists can't do the right thing how can we expect the general practicitioners to do any better?