Recognition and Management of Chronic Kidney Disease in an Elderly Ambulatory Population

  • Michael B. Rothberg
  • Eileen D. Kehoe
  • Abbie L. Courtemanche
  • Thabo Kenosi
  • Penelope S. Pekow
  • Maura J. Brennan
  • Jeffrey G. Mulhern
  • Gregory L. Braden
Original Article

DOI: 10.1007/s11606-008-0607-z

Cite this article as:
Rothberg, M.B., Kehoe, E.D., Courtemanche, A.L. et al. J GEN INTERN MED (2008) 23: 1125. doi:10.1007/s11606-008-0607-z

Abstract

Background

Chronic kidney disease (CKD) is a growing problem among the elderly. Early detection is considered essential to ensure proper treatment and to avoid drug toxicity, but detection is challenging because elderly patients with CKD often have normal serum creatinine levels. We hypothesized that most cases of CKD in the elderly would go undetected, resulting in inappropriate prescribing.

Objective

To determine whether recognition of CKD is associated with more appropriate treatment

Design

Retrospective chart review

Participants

All patients aged ≥65 years with a measured serum creatinine in the past 3 years at 2 inner city academic health centers.

Measurements

Estimated glomerular filtration rate (eGFR) calculated using the Modified Diet in Renal Disease equation, and for patients with eGFR < 60, documentation of CKD by the provider, diagnostic testing, nephrology referral and prescription of appropriate or contraindicated medications.

Results

Of 814 patients with sufficient information to estimate eGFR, 192 (33%) had moderate (eGFR < 60 mL/min) and 5% had severe (eGFR < 30 mL/min) CKD. Providers identified 38% of moderate and 87% of severe CKD. Compared to patients without recognized CKD, recognized patients were more likely to receive an ACE/ARB (80% vs 61%, p = .001), a nephrology referral (58% vs 2%, p < .0001), or urine testing (75% vs 47%, p < .0001), and less likely to receive contraindicated medications (26% vs 40%, p = .013).

Conclusions

Physicians frequently fail to diagnose CKD in the elderly, leading to inappropriate treatment. Efforts should focus on helping physicians better identify patients with low GFR.

KEY WORDS

chronic kidney diseasediagnosiscreatinineace inhibitorselderly

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Michael B. Rothberg
    • 1
    • 3
  • Eileen D. Kehoe
    • 2
    • 3
  • Abbie L. Courtemanche
    • 1
    • 3
  • Thabo Kenosi
    • 1
    • 3
  • Penelope S. Pekow
    • 4
  • Maura J. Brennan
    • 1
    • 3
  • Jeffrey G. Mulhern
    • 2
    • 3
  • Gregory L. Braden
    • 2
    • 3
  1. 1.Division of General Medicine and GeriatricsBaystate Medical CenterSpringfieldUSA
  2. 2.Division of Nephrology, Department of MedicineBaystate Medical CenterSpringfieldUSA
  3. 3.Tufts University School of MedicineBostonUSA
  4. 4.The School of Public HealthUniversity of MassachusettsAmherstUSA