Management of patients with chronic kidney disease: a French medical centre database analysis.

IF 2.4 4区医学 Q1 MEDICINE, GENERAL & INTERNAL Family practice Pub Date : 2024-06-12 DOI:10.1093/fampra/cmad004

Matthieu Ariza, Steven Martin, Mikaël Dusenne, David Darmon, Matthieu Schuers

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Abstract

Objective(s): Chronic kidney disease (CKD) is an insidious disease that requires early nephroprotective measures to delay progression to end-stage kidney disease. The objective of this study was to describe the management of patients with CKD in primary care, including clinical and biological monitoring and prescribed treatments. A retrospective, single-centre study was conducted on adult patients who were treated in the Maison de Neufchâtel (France) between 2012 and 2017 at least once a year. The inclusion criteria were 2 estimated glomerular filtration rate (eGFR) measurements <60 mL/min more than 3 months apart. Two subgroups were constituted according to whether CKD was coded in the electronic medical records (EMRs).

Results: A total of 291 (6.7%, CI95% 5.9-7.4) patients with CKD were included. The mean eGFR was 51.0 ± 16.4 mL/min. Hypertension was the most frequent health problem reported (n = 93, 32%). Nephrotective agents were prescribed in 194 (66.7%) patients, non-steroidal anti-inflammatory drugs (NSAIDs) in 22 (8%) patients, and proton-pump inhibitors (PPIs) in 147 (47%) patients. CKD coding in EMRs was associated with dosage of natraemia (n = 34, 100%, P < 0.01), albuminuria (n = 20, 58%, P < 0.01), vitamin D (n = 14, 41%, P < 0.001), and phosphorus (n = 11, 32%, P < 0.001). Eighty-one patients (31.5%) with low eGFR without an entered code for CKD were prescribed an albuminuria dosage. Clinical monitoring could not be analysed due to poor coding.

Conclusion: This pilot study reinforces the hypothesis that CKD is underscreened and undermanaged. More systematic coding of medical information in EMRs and further studies on medical centre databases should improve primary care practices.

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慢性肾病患者的管理：法国医疗中心数据库分析。

目的：慢性肾脏病（CKD）是一种隐匿性疾病：慢性肾脏病（CKD）是一种隐匿性疾病，需要尽早采取肾脏保护措施，以延缓发展为终末期肾脏病。本研究旨在描述初级医疗机构对慢性肾脏病患者的管理，包括临床和生物监测以及处方治疗。这项回顾性单中心研究的对象是2012年至2017年间在法国新堡医院接受治疗的成年患者，每年至少接受一次治疗。纳入标准为两次估计肾小球滤过率（eGFR）测量结果：共纳入 291 名（6.7%，CI95% 5.9-7.4）慢性肾脏病患者。平均 eGFR 为 51.0 ± 16.4 mL/min。高血压是最常见的健康问题（n = 93，32%）。194名患者（66.7%）使用了肾脏保护剂，22名患者（8%）使用了非甾体抗炎药（NSAIDs），147名患者（47%）使用了质子泵抑制剂（PPIs）。EMR中的CKD编码与正铁血症（34人，100%，P＜0.01）、白蛋白尿（20人，58%，P＜0.01）、维生素D（14人，41%，P＜0.001）和磷（11人，32%，P＜0.001）的剂量有关。81名（31.5%）低 eGFR 但未输入 CKD 代码的患者被处方了白蛋白尿剂量。由于编码不准确，无法对临床监测结果进行分析：这项试点研究加强了 CKD 未得到充分筛查和管理的假设。对 EMR 中的医疗信息进行更系统的编码，并对医疗中心数据库进行进一步研究，应能改善初级保健实践。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Family practice 医学-医学：内科

CiteScore

4.30

自引率

9.10%

发文量

144

审稿时长

4-8 weeks

期刊介绍： Family Practice is an international journal aimed at practitioners, teachers, and researchers in the fields of family medicine, general practice, and primary care in both developed and developing countries. Family Practice offers its readership an international view of the problems and preoccupations in the field, while providing a medium of instruction and exploration. The journal''s range and content covers such areas as health care delivery, epidemiology, public health, and clinical case studies. The journal aims to be interdisciplinary and contributions from other disciplines of medicine and social science are always welcomed.