PCPs Support Kidney Disease Guidelines but Cite Barriers

Primary care physicians (PCPs) generally agree with clinical practice guidelines for chronic kidney disease (CKD), but they are less familiar with albuminuria, and they perceive barriers to its measurement, reports a study in BMC Nephrology.

An Internet survey evaluating knowledge, beliefs, attitudes, self-reported behavior, and perceived barriers to CKD care was sent to 12,000 PCPs in the United States. Of 848 physicians who opened the email, 165 responded (19.5 percent response rate). Eighty-eight percent of respondents spent more than half their time in clinical care, and 46 percent were in private practice.

Ninety-six percent of PCPs agreed that estimated GFR (eGFR) was useful in assessing kidney function. More than 70 percent believed that albuminuria testing would be useful. However, 20 percent said that a dipstick would not be helpful because of low reliability, and 30 percent thought that quantitative albuminuria testing would be burdensome to the patient.

In nondiabetic patients with hypertension, 75 percent of PCPs reported testing for albuminuria at an eGFR greater than 60 mL/min/1.73 m2 and 91 percent at less than 60 mL/min/1.73 m2. The respondents cited lack of effect on management, time limitations, and they perceived an absence of guidelines as barriers to albuminuria testing,

Although they broadly agreed with the definition of CKD, 30 percent of PCPs expressed concern about overdiagnosis in older patients at eGFR values in the stage 3a range. They agreed that angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers improved CKD outcomes, although agreement was lower at severe versus moderate albuminuria. About half of the PCPs stated that they were unfamiliar with CKD guidelines but were open to interventions aimed at improving CKD care.

Most CKD patients not receiving dialysis are treated by PCPs. This survey study suggests that most American PCPs agree with the current CKD guidelines. Efforts are needed to help PCPs become more familiar with CKD guidelines, to address barriers to albuminuria testing, and to help in targeting therapy with angiotensin-converting enzyme inhibitors and angotensin II receptor blockers [Abdel-Kader K, et al. Primary care physicians’ familiarity, beliefs, and perceived barriers to practice guidelines in non-diabetic CKD: a survey study. BMC Nephrol 2014; 15:64].