Related Experiment Video
Updated: Jul 10, 2026
5/6 Nephrectomy Using Sharp Bipolectomy Via Midline Laparotomy in Rats
Published on: April 4, 2025
Evaluation and treatment of CKD patients before and at their first nephrologist encounter in Canada
Bryan M Curtis1, Brendan J Barrett, Ognjenka Djurdjev
1Division of Nephrology and Clinical Epidemiology, Memorial University of Newfoundland, St John's, Newfoundland, Canada. bcurtis@mun.ca
Insights
Patients with chronic kidney disease (CKD) are often seen late by nephrologists in Canada. Early CKD interventions are underutilized, indicating a need for improved evaluation and treatment strategies.
Area of Science:
- Nephrology
- Internal Medicine
- Public Health
Background:
- Comorbidities in chronic kidney disease (CKD) often manifest early.
- Effective interventions exist to slow CKD progression and reduce mortality.
- This study investigates the utilization of these interventions in CKD patients in Canada.
Purpose of the Study:
- To characterize CKD patients at their first nephrologist visit in Canada.
- To assess the evaluation and management of CKD complications and cardiac risk factors before and during the initial nephrology encounter.
- To determine the availability and use of allied health professional services in CKD care.
Main Methods:
- Prospective, multicenter cohort study involving 482 patients with estimated glomerular filtration rate < 50 mL/min/1.73 m(2).
- Data collected on patient characteristics, prior evaluations, management changes by nephrologists, and allied health professional involvement.
- Exclusion criteria included acute kidney failure or anticipated need for dialysis within 3 months.
Main Results:
- Patients presented with advanced CKD (mean eGFR 29 mL/min/1.73 m(2)) and were older (mean 69.7 years).
- Incomplete transmission of prior evaluation results was noted.
- Suboptimal evaluation and treatment of CKD complications (e.g., parathyroid hormone, lipids, iron studies) and cardiovascular risk factors (e.g., renin-angiotensin system inhibitors, aspirin, statins) were observed.
Conclusions:
- CKD patients in Canada are frequently referred late to nephrologists, often at Stage IV.
- Incomplete information transfer hinders optimal care.
- There is significant potential for enhancing the evaluation and management of CKD patients during their initial nephrology consultations.
Background:
Much of the comorbidity associated with chronic kidney disease (CKD) begins in the early stages. Interventions with proven efficacy exist to decrease progression, morbidity, and mortality. This study examines their use in patients with CKD before and at their first nephrologist encounter in Canada.
Study Design:
Prospective multicenter cohort study.
Setting & Participants:
482 patients at their first nephrologist encounter enrolled from 13 Canadian centers. Inclusion criteria were measured or estimated glomerular filtration rate less than 50 mL/min/1.73 m(2). Exclusion criteria were patients with acute kidney failure or those likely to require dialysis therapy within 3 months of referral.
Outcomes & Measurements:
Describe: (1) characteristics of patients at their first nephrology encounter in Canada; (2) the evaluation for cardiac risk factors, cardiac diseases and CKD complications and their management before the encounter; (3) changes in management initiated by nephrologists at the first encounter; and (4) the availability and use of allied health professional services for CKD care.
Results:
Patients had a mean age of 69.7 years, estimated glomerular filtration rate of 29 mL/min/1.73 m(2) (0.48 mL/s/1.73 m(2), hemoglobin level of 12.1 g/dL (121 g/L), albumin level of 3.6 g/dL (36 g/L), and blood pressure of 147/76 mm Hg. Transmission of results from prior evaluation was variable. At the encounter, nephrologists had available or ordered albumin and calcium/phosphate tests in greater than 70% of patients. Nephrologists did not evaluate parathyroid hormone in 83% of patients, lipids in greater than 50%, iron studies (in those with anemia) in 57%, and urine studies in 30%. Despite a high prevalence of diabetes and coronary artery disease, only 46% were administered medications to interrupt the renin-angiotensin system, 37% were administered acetylsalicylic acid, and 32% were administered lipid medication after the encounter. Availability and use of allied health professional resources varied and was low in an unstructured setting.
Limitations:
External validity, referral bias, and inability to make causal inferences.
Conclusions:
In Canada, patients with CKD continue to be encountered late by nephrologists (stage IV CKD). Information for prior evaluation is incompletely transmitted. Finally, there appears to be room for improvement in evaluation and treatment at the first nephrologist encounter.
Related Concept Videos
01:28Chronic Kidney Disease III: Interprofessional Care
01:25Chronic Kidney Disease I: Introduction
01:18Chronic Kidney Disease IV: Nursing Management
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:20Acute Kidney Injury V: Interprofessional Care
01:16Kidney Transplant III: Nursing Management