The quality of care for patients with CKD showed no improvements between 2006 and 2014, with recommended treatments frequently underused, according to a recently published study.
“Improving the quality of CKD care has important public health implications to delay disease progression and prevent ESKD,” Sri Lekha Tummalapalli, MD, MBA, of the University of California San Francisco, and colleagues wrote. “National trends of the quality of CKD care are not well established. Furthermore, it is unknown whether gaps in quality of care are due to lack of physician awareness of CKD status of patients or other factors. In this study we assess temporal trends in the quality of CKD care [and] we examine the quality of CKD care among patients with physician-diagnosed CKD as a proxy for physician CKD awareness.”
Researchers conducted a national, serial, cross-sectional study of patients with CKD who visited office-based ambulatory care practices between 2006 and 2014 (mean age, 69 years; 53% men; 69% non-Hispanic white).
Considered factors included blood pressure measurement, uncontrolled hypertension (defined as > 130/80 mm Hg), uncontrolled diabetes (HbA1c > 7%), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use among patients with hypertension, statin use in patients 50 years or older and nonsteroidal anti-inflammatory drug use.
The quality of care for patients with CKD showed no improvements between 2006 and 2014, with recommended treatments frequently underused.
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Change in quality performance over time was calculated using multivariable linear regression and chi-squared analysis.
Investigators found that uncontrolled diabetes occurred in 40% of patients between 2012 and 2014 and that, over time, there was no difference in the prevalence of uncontrolled hypertension (46% in 2006-2008 vs. 48% in 2012-2014).
Regarding treatment guidelines, the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers declined from 45% between 2006 and 2008 to 36% between 2012 and 2014 and statin use was consistently low, with a prevalence of 29% between 2006 and 2008 and 31% between 2012 and 2015.
“Despite the introduction of multiple national quality reporting programs and CKD-specific guidelines during our study period, we did not see improvement in quality of CKD care over time,” the researchers wrote. “The majority of CKD is treated in primary care settings, and therefore, efforts toward improved CKD management must involve primary care physicians as a central component of multi-specialty care teams. Primary care physicians may have skepticism that monitoring CKD improves care, which may drive worse quality. Additional barriers include limited time, competing demands, and difficulties obtaining and using data. Effective management of hypertension and diabetes requires medication adherence and patient behavior change, which is difficult to achieve.
[There is] an urgent need for CKD-specific quality measures and implementation of quality improvement interventions.” – by Melissa J. Webb
Disclosures: Tummalapalli reports support from the National Institute of Diabetes and Digestive Kidney Diseases 2T32DK007219-41 Training Grant to the University of California San Francisco. The other authors report no relevant financial disclosures.