An assessment of cholesterol goal attainment in patients with chronic kidney disease

Stadler, Sheila L.; Bhardwaja, Bharati; Olson, Kari L.; Powers, J. David; Lanese, Diane M.

doi:10.1016/j.jacl.2010.06.005

Cited by 13 publications

(7 citation statements)

References 46 publications

(35 reference statements)

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“…44 Our results are higher than the statin-prescribing proportions observed by previous studies in the United States (ranging from 16% to 57%). 39,45,[49][50][51] Our results are more consistent with studies in Australia and Asia (ranging from 59% to 87%) and a study in the Netherlands (74%). 36,48,52,53 We only looked at statin prescribing up until 2012; guidelines recommending statin use for patients with chronic kidney disease were released in 2013, 54 so there may be improvement in more recent years.…”

Section: Discussionsupporting

confidence: 91%

Quality of Care for Patients With Chronic Kidney Disease in the Primary Care Setting: A Retrospective Cohort Study From Ontario, Canada

Nash

Brimble

Markle‐Reid

et al. 2017

Can J Kidney Health Dis

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Background:Patients with chronic kidney disease may not be receiving recommended primary renal care.Objective:To use recently established primary care quality indicators for chronic kidney disease to determine the proportion of patients receiving recommended renal care.Design:Retrospective cohort study using administrative data with linked laboratory information.Setting:The study was conducted in Ontario, Canada, from 2006 to 2012.Patients:Patients over 40 years with chronic kidney disease or abnormal kidney function in primary care were included.Measurements:In total, 11 quality indicators were assessed for chronic kidney disease identified through a Delphi panel in areas of screening, monitoring, drug prescribing, and laboratory monitoring after initiating an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB).Methods:We calculated the proportion and cumulative incidence at the end of follow-up of patients meeting each indicator and stratified results by age, sex, cohort entry, and chronic kidney disease stage.Results:Less than half of patients received follow-up tests after an initial abnormal kidney function result. Most patients with chronic kidney disease received regular monitoring of serum creatinine (91%), but urine albumin-to-creatinine monitoring was lower (70%). A total of 84% of patients age 66 and older did not receive a non-steroidal anti-inflammatory drug prescription of at least 2-week duration. Three quarters of patients age 66 and older were on an ACE inhibitor or ARB, and 96% did not receive an ACE inhibitor and ARB concurrently. Among patients 66 to 80 years of age with chronic kidney disease, 65% were on a statin. One quarter of patients age 66 and older who initiated an ACE inhibitor or ARB had their serum creatinine and potassium monitored within 7 to 30 days.Limitations:This study was limited to people in Ontario with linked laboratory information.Conclusions:There was generally strong performance across many of the quality of care indicators. Areas where more attention may be needed are laboratory testing to confirm initial abnormal kidney function test results and monitoring serum creatinine and potassium after initiating a new ACE inhibitor or ARB.

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Section: Discussionsupporting

confidence: 91%

Quality of Care for Patients With Chronic Kidney Disease in the Primary Care Setting: A Retrospective Cohort Study From Ontario, Canada

Nash

Brimble

Markle‐Reid

et al. 2017

Can J Kidney Health Dis

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“…These goals are largely not being met in clinical practice 29,30. Physicians must improve at controlling hypertension and hyperlipidemia, which are major risk factors for cardiovascular disease in patients with even mild CKD.…”

Section: Discussionmentioning

confidence: 99%

Mild and moderate pre-dialysis chronic kidney disease is associated with increased coronary artery calcium

Cespedes¹,

Li²,

Choi³

et al. 2011

VHRM

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BackgroundIt is increasingly evident that patients with chronic kidney disease (CKD) are more likely to die from heart disease than kidney failure. This study evaluated whether pre- dialysis CKD is an independent risk factor for coronary artery calcium (CAC).MethodsA total of 544 consecutive patients who underwent CAC scoring were analyzed. Eleven patients requiring hemodialysis were excluded. Patients were divided into three groups: normal glomerular filtration rate (GFR) (GFR > 90 mL/min/1.73 m2), mild CKD (90 ≥ GFR > 60 mL/min/1.73 m2), and moderate CKD (60 ≥ GFR > 30 mL/min/1.73 m2). Continuous and categorical variables were compared using analysis of variance and the χ2 statistic. A multiple logistic regression model was used for detecting the association between total CAC score and GFR. An unadjusted model was used, followed by a second model adjusted for covariates known to be related to CAC. Another multivariable binary logistic model predicting the presence of CAC (>10) was performed and odds of incidence of CAC (>10) were calculated among the three GFR subgroups.ResultsAfter adjustment for covariates, patients with mild CKD had mean CAC scores 175 points higher than those with the referent normal GFR (P = 0.048), while those with moderate CKD had mean CAC scores 693 points higher than the referent (P < 0.001). After adjustment for covariates, patients with mild CKD were found to be 2.2 times more likely (95% confidence interval 1.3–3.7, P = 0.004) and patients with moderate CKD were 6.4 times more likely (95% confidence interval 2.9–14.3, P < 0.001) to have incident CAC compared with the group with normal GFR.ConclusionMild and moderate pre-dialysis CKD are independent risk factors for increased mean and incident CAC.

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“…7 Studies in the United States have found that the proportion of patients with CKD on statins range from 30% to 47%. [8][9][10] A large observational study in the United Kingdom also found that under half of the patients with CKD were prescribed a statin. 11 To improve quality of care, it is important to determine the perceived barriers to providing appropriate care for patients with CKD among family physicians.…”

Section: Quality Of Care For Patients With Ckdmentioning

confidence: 99%

Improving Care for Patients With or at Risk for Chronic Kidney Disease Using Electronic Medical Record Interventions: A Pragmatic Cluster-Randomized Trial Protocol

Nash

Ivers

Young

et al. 2017

Can J Kidney Health Dis

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Background:Many patients with or at risk for chronic kidney disease (CKD) in the primary care setting are not receiving recommended care.Objective:The objective of this study is to determine whether a multifaceted, low-cost intervention compared with usual care improves the care of patients with or at risk for CKD in the primary care setting.Design:A pragmatic cluster-randomized trial, with an embedded qualitative process evaluation, will be conducted.Setting:The study population comes from the Electronic Medical Record Administrative data Linked Database®, which includes clinical data for more than 140 000 rostered adults cared for by 194 family physicians in 34 clinics across Ontario, Canada. The 34 primary care clinics will be randomized to the intervention or control group.Intervention:The intervention group will receive resources from the “CKD toolkit” to help improve care including practice audit and feedback, printed educational materials for physicians and patients, electronic decision support and reminders, and implementation support.Measurements:Patients with or at risk for CKD within participating clinics will be identified using laboratory data in the electronic medical records. Outcomes will be assessed after dissemination of the CKD tools and after 2 rounds of feedback on performance on quality indicators have been sent to the physicians using information from the electronic medical records. The primary outcome is the proportion of patients aged 50 to 80 years with nondialysis-dependent CKD who are on a statin. Secondary outcomes include process of care measures such as screening tests, CKD recognition, monitoring tests, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker prescriptions, blood pressure targets met, and nephrologist referral. Hierarchical analytic modeling will be performed to account for clustering. Semistructured interviews will be conducted with a random purposeful sample of physicians in the intervention group to understand why the intervention achieved the observed effects.Conclusions:If our intervention improves care, then the CKD toolkit can be adapted and scaled for use in other primary care clinics which use electronic medical records.Trial Registration:ClinicalTrials.gov Identifier: NCT02274298

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An assessment of cholesterol goal attainment in patients with chronic kidney disease

Cited by 13 publications

References 46 publications

Quality of Care for Patients With Chronic Kidney Disease in the Primary Care Setting: A Retrospective Cohort Study From Ontario, Canada

Quality of Care for Patients With Chronic Kidney Disease in the Primary Care Setting: A Retrospective Cohort Study From Ontario, Canada

Mild and moderate pre-dialysis chronic kidney disease is associated with increased coronary artery calcium

Improving Care for Patients With or at Risk for Chronic Kidney Disease Using Electronic Medical Record Interventions: A Pragmatic Cluster-Randomized Trial Protocol

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