Recognition of chronic kidney disease in a general medicine outpatient clinic

Chronic kidney disease (CKD) is a major health problem. Recent emphasis has been to prevent the progression of CKD. We used chart audits to see if CKD was an under-recognized condition in a general medicine resident clinic. Data focused on recognition of CKD, 3 or 4, evaluation of metabolic bone disease, and anemia. A multifaceted educational initiative was developed and occurred between 2005 and 2010. Three retrospective chart audits were performed, in 2005 prior to the education and again in 2007 and 2010. In 2005, less than one-fifth of patients were identified as CKD, 3 or 4. Evaluation of bone disease and anemia is similar. Initial results were reviewed with the residents and handouts for metabolic bone monitoring were developed. Wall charts of the handouts were also posted. In 2007, CKD recognition increased slightly, but more patients had bone disease and anemia evaluations. After 2007, the only educational intervention was a CKD lecture given yearly. In 2010, the audit saw decreased recognition of CKD and a decline in metabolic bone monitoring. Although complete blood count (CBC) monitoring decreased, iron studies increased to 50% of patients. We conclude that despite educational initiatives and re-enforcement efforts with the internal medicine residents and attending staff, major issues related to CKD are not being recognized or addressed. With an increasing CKD population, attempts must be made to improve recognition and management. Novel strategies need to be developed.