PC Docs Face Obstacles Identifying, Managing Chronic Kidney Disease

Primary care physicians complain about a lack of access to CKD clinical information systems, insufficient patient education materials.

The federal government's efforts to reduce by 25% the number of people developing end-stage kidney disease in the next decade may be hobbled the lack of knowledge and support tools made available to primary care physicians.

That's according to a new study in PloS ONE, which suggests that more resources will be needed to achieve the goals set in July by the Department of Health and Human Services.

"If we hope to reduce the personal and financial toll of chronic kidney disease and end-stage kidney failure, primary care physicians must be key players, said John Sperati, MD, associate professor of medicine at the Johns Hopkins University School of Medicine and director of the school's Nephrology Fellowship Training Program.

"And we as kidney specialists need to form better partnerships with PCPs, and need to offer more training and resources to them," he said.

Sperati and colleagues at Johns Hopkins heard from four focus groups comprised of more than 30 primary care physicians across the nation, and found that many of them don't have the knowledge or the tools to identify and manage patients with chronic kidney disease, especially in the early stages of the disease.  

An estimated 37 million people, about 15% of the nation's adult population, are believed to be affected by CKD, with high blood pressure and diabetes being major contributors to the disease.

Medicare costs for CKD in 2016 were $79 billion, and another $35 billion for end-stage renal disease, According to the U.S. Renal Data System. HHS hopes that by identifying those at risk of CKD in its early stages, lifestyle adjustments, medications, and disease management can delay expensive, invasive countermeasures, such as dialysis and transplants.   

To reach that goal, primary care physicians will be a key player, Sperati said, because there is a nationwide shortage of nephrologists, with only about one kidney specialist for every 2,000 patients with CKD. Those specialists, he notes, focus on the 8% of CKD patients in advanced stages with multiple complications or end-stage kidney failure.

That means that PCPs will have to provide the care for CKD in its early stages. Despite how prevalent this disease is, Sperati believes that, if managed early on by PCPs, some patients can avoid advanced stages.   

Almost 85% of the PCPs in the researchers' focus groups said they felt comfortable managing patients with early-stage CKD, but not comfortable managing specific complications such as anemia (44%), bone disorders (72%) and excess metabolic acid in the body that damages the kidneys (69%), the researchers found.

Most of the docs complained that they lacked access to clinical information systems and insufficient patient education material about CKD. They also complained about the lack of time they had to spend with patients, along with system-level barriers such as poor reimbursements for delivering care to complex CKD patients. 

The PCPs identified patient barriers to management, such as limited understandings of the implications of CKD and the costs associated with meds, tests and other costs.

To improve early diagnosis of CKD, the focus group physicians called for: more access to automatic estimated glomerular filtration rate (eGFR) reports to screen for low levels of GFR clear; guidelines for treatment; better education; and improved insurance coverage and physician reimbursement for services and care.

"This is very helpful information in identifying what primary care physicians see as barriers but also as potential solutions," Sperati said. 

This study was funded by the National Kidney Foundation and no author declared any conflict of interest.