Physician utilization, risk-factor control, and CKD progression among participants in the Kidney Early Evaluation...

Area of Science:

• Nephrology
• Cardiology
• Public Health

Background:

• Chronic kidney disease (CKD) significantly increases cardiovascular mortality risk.
• The relationship between physician utilization and cardiovascular disease (CVD) risk-factor control in CKD patients is not well understood.
• Data from the National Kidney Foundation's Kidney Early Evaluation Program (KEEP) from 2005-2010 were analyzed.

Purpose of the Study:

• To examine the association between physician utilization and cardiovascular disease risk-factor control in patients with CKD.
• To assess risk-factor control at first and subsequent screenings within the KEEP cohort.

Main Methods:

• Cardiovascular risk factors included blood pressure, glycemia, and cholesterol levels.
• Multinomial logistic regression analyzed the association between participant characteristics and nephrologist visits, adjusting for kidney function.
• Paired t tests or McNemar tests compared characteristics between first and second screenings.

Main Results:

• Of 90,009 participants, only 2.9% had seen a nephrologist.
• Achieving target levels for all risk factors was higher in patients seeing a nephrologist (9.9%) or another specialist (10.3%) compared to those with only a primary care physician (8.3%) or no physician (7.2%).
• Only 12.3% of participants meeting criteria for nephrology consultation saw a nephrologist; this increased to 19.7% among those returning for a second screening. Risk factor control improved from 13.3% to 20.9% by the second screening.

Conclusions:

• Cardiovascular risk-factor control is suboptimal in the KEEP population.
• Nephrologist utilization is low, but associated with improved risk-factor control, especially after initial screening.
• Addressing communication barriers between nephrologists and primary care physicians is a potential focus for the KEEP program.