Low documentation of chronic kidney disease among high-risk patients in a managed care population: a retrospective cohort study

• Type of Material: Article
• Authors: Idris Guessous, Emory University; William McClellan, Emory University; Suma Vupputuri, Emory University; Monnie Wasse, Emory University
• Language: English
• Date: 2009-09-16
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2009 Guessous et al; licensee BioMed Central Ltd
• License: Creative Commons Attribution 2.0 Generic
• Final Published Version (URL): http://www.biomedcentral.com/1471-2369/10/25
• Title of Journal or Parent Work: BMC Nephrology
• ISSN: 1471-2369
• Volume: 10
• Issue: 25
• Start Page: 1
• End Page: 10
• Grant/Funding Information: IG: supported, in part, by a grant from the Swiss Foundation for Science (33CM30-124087).; HW: supported, in part, by NIH K23 Career Development Award.
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology

Abstract

Background Early detection of chronic kidney disease (CKD) is sub-optimal among the general population and among high risk patients. The prevalence and impact of major CKD risk factors, diabetes (DM) and hypertension (HTN), on CKD documentation among managed care populations have not been previously reported. We examined this issue in a Kaiser Permanente Georgia (KPG) CKD cohort. Methods KPG enrollees were included in the CKD cohort if they had eGFRs between 60 and 365 days apart that were <90 ml/min during 1999-2006. The current analysis is restricted to participants with eGFR 10-59 ml/min/1.73 m2. CKD documentation was defined as a presenting diagnosis of CKD by a primary care physician or nephrologist using ICD-9 event codes. The association between CKD documentation and DM and HTN were assessed with multivariate logistic regression models. Results Of the 50,438 subjects within the overall KPG CKD cohort, 20% (N = 10,266) were eligible for inclusion in the current analysis. Overall, CKD diagnosis documentation was low; only 14.4% of subjects had an event-based CKD diagnosis at baseline. Gender and types 2 diabetes interacted on CKD documentation. The prevalence of CKD documentation increased with the presence of hypertension and/or type 2 diabetes, but type 2 diabetes had a lower effect on CKD documentation. In multivariate analysis, significant predictors of CKD documentation were eGFR, hypertension, type 2 diabetes, congestive heart failure, peripheral artery disease, statin use, age and gender. CKD documentation was lower among women than similarly affected men. Conclusion Among patients with an eGFR 10-59, documentation of CKD diagnosis by primary and subspecialty providers is low within a managed care patient cohort. Gender disparities in CKD documentation observed in the general population were also present among KPG CKD enrollees.