Dr. Chester Fox with his patient
Primary care physicians spend very little time discussing risk factors and preventative steps with patients at risk for kidney disease, and new research, to be presented this month at the National Kidney Foundation 2011 Spring Clinical Meetings, is trying to change that.
"Primary care physicians are our first line of defense against one of the world's top killers," said Lynda A. Szczech, MD, MSCE, President of the National Kidney Foundation. "More than 26 million Americans already have chronic kidney disease, and millions more are at risk and don't even know it. We don't want those at risk to join the 570,000 Americans with kidney failure — we need doctors to communicate with their patients about what they can do to protect their kidneys over the long term."
In one study, Dr. Kimberly Carter and her colleagues at the Vanderbilt University Medical Center found that only half of primary care doctors discussed chronic kidney disease, or CKD, with their diabetic patients, who are all at risk of developing CKD. And when it was discussed, half of doctors spoke about CKD for 33 seconds or less - an average of only 3% of the total visit time.
Many doctors ordered the appropriate lab tests, but didn't explain to patients what they were for, and that's a missed opportunity, she added.
"It's important to discuss tests and other procedures so patients can learn about what they can do to prevent kidney disease, and what they need to pay attention to when they go about their daily lives," said Dr. Carter. "There are many things patients can do - such as keeping their blood pressure under control, following a low-salt diet, and avoiding some medications that are toxic to the kidneys- and it's empowering for them to know that."
Another study, also being presented at the Clinical Meetings, is investigating ways to help primary care physicians tackle the growing problem of CKD. Dr. Chester Fox and his colleagues at the University of Buffalo Primary Care Research Institute are following 12 practices to determine how best to help physicians diagnose CKD and manage its complications.
In one group, doctors received software that extracted key points from a patient's electronic medical record, such as the need for a new laboratory test. Other groups received regular visits from a practice facilitator, who helped administrators and other members of a clinical practice streamline and improve record-keeping, for instance.
Preliminary results show that some practices really benefit from the initiatives, dramatically increasing the diagnosis of CKD and managing its risk factors and co-morbidities.
"CKD is highly prevalent in primary care offices, yet it's under-recognized," said Dr. Fox. "I want primary care doctors to know about CKD, to put patients on medications that can help them, to remove medications that can increase their risk and to recognize the signs of kidney failure."
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