CKD as an underrecognized threat to patient safety

Abstract

Chronic kidney disease (CKD) is common, but underrecognized, in patients in the health care system, where improving patient safety is a high priority. Poor disease recognition and several other features of CKD make it a high-risk condition for adverse safety events. In this review, we discuss the unique attributes of CKD that make it a high-risk condition for patient safety mishaps. We point out that adverse safety events in this disease have the potential to contribute to disease progression; namely, accelerated loss of kidney function and increased incidence of end-stage renal disease. We also propose a framework in which to consider patient safety in CKD, highlighting the need for disease-specific safety indicators that reflect unsafe practices in the treatment of this disease. Finally, we discuss the hypothesis that increased recognition of CKD will reduce disease-specific safety events and in this way decrease the likelihood of adverse outcomes, including an accelerated rate of kidney function loss and increased incidence of end-stage renal disease.

Figure 1

A theoretical patient with chronic kidney disease is subject to several events which might be classified as preventable and related to patient safety. These events contribute to an accelerated rate of kidney function decay.

Figure 2

The Donabedian structure-process-outcome framework applied to the chronic kidney disease model. The model proposes a causal link between the disease-specific structural deficit of poor disease recognition and adverse disease outcomes, mediated through several candidate disease-specific safety measures.