Reporting of estimated GFR in the primary care clinic

Abstract

Background: Because serum creatinine is an insensitive measure of kidney dysfunction, guidelines have advocated routine use of estimated glomerular filtration rate (eGFR) to identify patients with chronic kidney disease (CKD). Patients with early (stage 3) CKD remain undiagnosed in primary care clinics; therefore, we hypothesized that routine reporting of eGFR in outpatient clinics would improve the recognition and treatment of CKD.

Methods: A retrospective review of primary care patients was undertaken at the Bronx Veterans Affairs Medical Center, Bronx, New York, before and after the institution of routine eGFR reporting. We evaluated the achievement of diagnostic and therapeutic treatment goals based on the Kidney Disease Outcomes Quality Initiative guidelines (documentation of CKD, urinalysis assessment, blood pressure < 130/80 mm Hg, and renin-angiotensin system blockade) for patients with stage 3 CKD during each period.

Results: Overall, patients with diabetes with early-stage CKD achieved superior treatment rates than similar patients without diabetes. Routine reporting of eGFR improved the documentation and identification of CKD by almost 50%, although absolute improvement was modest. Use of renin-angiotensin system blockers improved minimally, as did blood pressure control. Patients with documented CKD achieved treatment goals more frequently than patients without documented CKD.

Conclusion: Routine reporting of eGFR alone modestly improved the identification of patients with CKD without a clinically significant effect on care. For Modification of Diet in Renal Disease Study calculation of eGFR reporting to effect improvements in CKD care, it will be necessary to pair eGFR reporting with provider education to identify these patients and treat them effectively.