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

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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.

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Acknowledgment

This study was supported by the Charlton Fund of Tufts University School of Medicine. The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. Dr. Rothberg is the recipient of a Doris Duke Clinical Scientist Development Award.

In addition, we would like to acknowledge Ricky Wong for his help in collecting the data and Chris Kenwood and Yan Liu for their help with the statistical analysis.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Division of General Medicine and Geriatrics, Baystate Medical Center, Springfield, MA, USA

    Michael B. Rothberg MD, MPH, Abbie L. Courtemanche DO, Thabo Kenosi MD & Maura J. Brennan MD

  2. Division of Nephrology, Department of Medicine, Baystate Medical Center, Springfield, MA, USA

    Eileen D. Kehoe MD, Jeffrey G. Mulhern MD & Gregory L. Braden MD

  3. Tufts University School of Medicine, Boston, MA, USA

    Michael B. Rothberg MD, MPH, Eileen D. Kehoe MD, Abbie L. Courtemanche DO, Thabo Kenosi MD, Maura J. Brennan MD, Jeffrey G. Mulhern MD & Gregory L. Braden MD

  4. The School of Public Health, University of Massachusetts, Amherst, MA, USA

    Penelope S. Pekow PhD

Authors
  1. Michael B. Rothberg MD, MPH
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  2. Eileen D. Kehoe MD
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  3. Abbie L. Courtemanche DO
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Corresponding author

Correspondence to Michael B. Rothberg MD, MPH.

Additional information

This paper was presented at the 2007 Annual Meeting of the American Geriatrics Society in Seattle, WA.

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Rothberg, M.B., Kehoe, E.D., Courtemanche, A.L. et al. Recognition and Management of Chronic Kidney Disease in an Elderly Ambulatory Population. J GEN INTERN MED 23, 1125–1130 (2008). https://doi.org/10.1007/s11606-008-0607-z

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  • DOI: https://doi.org/10.1007/s11606-008-0607-z

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