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Examining chronic kidney disease management in a single center
1Stanford University Medical Center, Division of Nephrology, M211, Department of Medicine, 300 Pasteur Road, Stanford, CA 94305-5114, USA. czar@stanford.edu
Clinical Nephrology
|November 5, 2004
Summary
Management of chronic kidney disease (CKD) shows improvement, yet many patients do not meet treatment targets for blood pressure, anemia, and cholesterol. Opportunities exist to optimize CKD patient care in outpatient settings.
Area of Science:
- Nephrology
- Internal Medicine
- Clinical Practice Guidelines
Background:
- Chronic kidney disease (CKD) management requires adherence to clinical practice guidelines.
- Outpatient clinics are key settings for managing CKD patients.
Purpose of the Study:
- To assess the achievement of care targets in CKD patients managed in outpatient clinics.
- Evaluate the current management practices against established clinical guidelines.
Main Methods:
- Reviewed 272 outpatient records of patients with elevated serum creatinine.
- Assessed blood pressure, anemia, bone disease, and lipid status.
- Evaluated therapeutic changes made during patient management.
Main Results:
- Patients had a mean age of 64 years, serum creatinine of 2.6 mg/dl, and GFR of 19.2 ml/min.
- Significant deviations from treatment targets were observed for blood pressure, hematocrit, calcium, phosphate, and cholesterol.
- Few patients with abnormal findings had their treatment altered; ACEi/ARB use was suboptimal in hypertensive patients, and lipid levels were rarely monitored.
Conclusions:
- While CKD management has seen improvements, substantial opportunities remain to optimize patient care.
- Current outpatient management frequently falls short of guideline-recommended targets for key CKD indicators.