Barriers to Successful Care for Chronic Kidney Disease

Oliver Lenz; Durga P Mekala; Daniel V Patel; Alessia Fornoni; David Metz; David Roth


BMC Nephrology. 2005;6 

In This Article

Abstract and Background

Background: The National Kidney Foundation has formulated clinical practice guidelines for patients with chronic kidney disease (K/DOQI). However, little is know about how many patients actually achieve these goals in a dedicated clinic for chronic kidney disease.
Methods: We performed a cross-sectional analysis of 198 patients with an estimated glomerular filtration rate of less than 30 ml/min/1.73 m2 and determined whether K/DOQI goals were met for calcium, phosphate, calcium-phosphate product, parathyroid hormone, albumin, bicarbonate, hemoglobin, lipids, and blood pressure.
Results: We found that only a small number of patients achieved K/DOQI targets. Recent referral to the nephrologist, failure to attend scheduled clinic appointments, African American ethnicity, diabetes, and advanced renal failure were significant predictors of low achievement of K/DOQI goals.
Conclusion: We conclude that raising awareness of chronic kidney disease and K/DOQI goals among primary care providers, early referral to a nephrologist, the exploration of socioeconomic barriers and cultural differences, and both patient and physician education are critical to improve CKD care in patients with Stage 4 and 5 CKD.

The National Kidney Foundation has recently launched a major effort to define Chronic Kidney Disease (CKD) and formulate clinical practice guidelines.[1,2] It has been clearly shown that complications of CKD, such as anemia, metabolic acidosis, nutritional deficits, secondary hyperparathyroidism, and hypertension, significantly contribute to morbidity and mortality.[3,4,5,6,7,8,9,10] It has been proposed that care for patients with CKD be best delivered in dedicated CKD clinics that provide a multidisciplinary approach to patients with CKD.[11,12] Typically, these clinics are staffed with nephrologists, dieticians, social workers, and educators, and the team works closely with vascular surgeons for access placement. However, little is known about the effectiveness of these clinics at academic centers. The purpose of this cross-sectional analysis is determine to what extent K/DOQI goals are achieved in a dedicated CKD clinic serving a urban, socio-economically disadvantaged minority population.