Chronic kidney disease management in an academic internal medicine clinic

Morrow, Benjamin D.; Stewart, Ian J.; Barnes, Eric W.; Cotant, Casey L.

doi:10.1007/s10157-009-0247-6

Cited by 6 publications

(9 citation statements)

References 28 publications

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“…Despite the publication of CKD practice guidelines, adoption among PCPs and nephrologists has been limited (7)(8)(9)(10). A survey involving 301 physicians who were presented a hypothetical with CKD showed that only 47% of nephrologists and 33% of internists could identify five of six laboratory tests indicated by guidelines (7).…”

Section: Discussionmentioning

confidence: 99%

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Implementation of a CKD Checklist for Primary Care Providers

Mendu

Schneider

Aizer³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives CKD is associated with significant morbidity, mortality, and financial burden. Practice guidelines outlining CKD management exist, but there is limited application of these guidelines. Interventions to improve CKD guideline adherence have been limited. This study evaluated a new CKD checklist (a tool outlining management guidelines for CKD) to determine whether implementation in an academic primary care clinic improved adherence to guidelines.Design, setting, participants, & measurements During a 1-year period (August 2012-August 2013), a prospective study was conducted among 13 primary care providers (PCPs), four of whom were assigned to use a CKD checklist incorporated into the electronic medical record during visits with patients with CKD stages 1-4. All providers received education regarding CKD guidelines. The intervention and control groups consisted of 105 and 263 patients, respectively. Adherence to CKD management guidelines was measured.Results A random-effects logistic regression analysis was performed to account for intra-group correlation by PCP assignment and adjusted for age and CKD stage. CKD care improved among patients whose PCPs were assigned to the checklist intervention compared with controls. Patients in the CKD checklist group were more likely than controls to have appropriate annual laboratory testing for albuminuria (odds ratio [OR], 7.9; 95% confidence interval [95% CI], 3.6 to 17.2), phosphate (OR, 3.5; 95% CI, 1.5 to 8.3), and parathyroid hormone (OR, 8.1; 95% CI, 4.8 to 13.7) (P,0.001 in all cases). Patients in the CKD checklist group had higher rates of achieving a hemoglobin A1c target,7% (OR, 2.7; 95% CI, 1.4 to 5.1), use of an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker (OR, 2.1; 95% CI, 1.0 to 4.2), documentation of avoidance of nonsteroidal anti-inflammatory drugs (OR, 41.7; 95% CI, 17.8 to 100.0), and vaccination for annual influenza (OR, 2.1; 95% CI, 1.1 to 4.0) and pneumococcus (OR, 4.7; 95% CI, 2.6 to 8.6) (P,0.001 in all cases).Conclusions Implementation of a CKD checklist significantly improved adherence to CKD management guidelines and delivery of CKD care.

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Section: Discussionmentioning

confidence: 99%

“…(6) However, studies have shown that primary care providers (PCPs) have limited knowledge of these guidelines (7)(8)(9)(10). There have been few interventions to improve adherence to CKD guidelines.…”

Section: Introductionmentioning

confidence: 99%

Implementation of a CKD Checklist for Primary Care Providers

Mendu

Schneider

Aizer³

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…The primary aims of treatment in patients with CKD are both to prevent or, at least slow, progression of CKD. However, available therapies are limited and include inhibitors of renin/angiotensin system (Locatelli et al, 2009;Morrow et al, 2010). However, these drugs are not able to completely block the progression.…”

Section: Suramin Inhibits Progression Of Renal Fibrosis 763mentioning

confidence: 99%

“…Given the high prevalence of CKD and cost of replacement therapies for ESRD, any treatment that halts or slows the progression of renal fibrosis has the potential to provide an immense medical, social, and economic benefit. At present, angiotensinconverting enzyme inhibitors and angiotensin II receptor type 1 blockers are clinically used to combat renal fibrosis (Locatelli et al, 2009;Morrow et al, 2010). However, these drugs are not able to completely stop the progression of renal fibrosis; in some conditions, such as aristolochic acid-induced renal fibrosis in rats, they are not effective at all (Debelle et al, 2004;Boor et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Delayed Administration of Suramin Attenuates the Progression of Renal Fibrosis in Obstructive Nephropathy

Liu

Tolbert²,

Ponnusamy³

et al. 2011

J Pharmacol Exp Ther

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We recently showed that suramin treatment prevents the onset of renal fibrosis in a model of obstructive nephropathy induced by unilateral ureteral obstruction (UUO). In this study, we further assessed the effect of delayed administration of suramin on the progression of tubulointerstitial fibrosis. Mice were given a single dose of suramin at 20 mg/kg starting at day 3 of obstruction, and kidneys were harvested after an additional 7 or 14 days of obstruction. Suramin completely blocked further increase in expression of type I collagen and fibronectin and largely suppressed expression of ␣-smooth muscle actin (␣-SMA) in both treatment groups. UUO injury induced phosphorylation of Smad-3, a key mediator of transforming growth factor-␤ (TGF-␤) signaling, epidermal growth factor receptor, and platelet-derived growth factor receptor after 3 days and further increased at 10 days after UUO injury. When suramin was administered at 3 days after obstruction, phosphorylation of these molecules was not further increased in the obstructed kidney. Suramin treatment also inhibited activation of signal transducer and activator of transcription 3 and extracellular signal-regulated kinase 1 and 2, two signaling pathways associated with renal fibrogenesis. Furthermore, delayed application of suramin suppressed TGF-␤1-induced expression of ␣-SMA and fibronectin in cultured renal interstitial fibroblasts. These results indicate that administration of suramin is effective in attenuating the progression of renal fibrosis after injury and suggest the potential clinical application of suramin as an antifibrotic treatment in patients with chronic kidney disease.

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“…52 Multiple studies identified disparities in the care of patients with resident PCPs (versus faculty PCPs), in areas such as diabetes care, cancer screening, discharge follow-up, and readmission rates. 43,[57][58][59][60][61][62] Given those disparities, further research is needed in assessing resident competence via EPAs and in determining what factors predict worse outcomes in patients seen by residents to identify areas for intervention and find the balance between autonomy and supervision.…”

Section: Evaluating Resident Practice and Performancementioning

confidence: 99%

A Decade of Teaching and Learning in Internal Medicine Ambulatory Education: A Scoping Review

Coyle

Helenius

Cruz

et al. 2019

Journal of Graduate Medical Education

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Background Ambulatory training in internal medicine residency programs has historically been considered less robust than inpatient-focused training, which prompted a 2009 revision of the Accreditation Council for Graduate Medical Education (ACGME) Program Requirements in Internal Medicine. This revision was intended to create a balance between inpatient and outpatient training standards and to spur innovation in the ambulatory setting. Objective We explored innovations in ambulatory education in internal medicine residency programs since the 2009 revision of the ACGME Program Requirements in Internal Medicine. Methods The authors conducted a scoping review of the literature from 2008 to 2017, searching PubMed, ERIC, and Scopus databases. Articles related to improving educational quality of ambulatory components of US-based internal medicine residency programs were eligible for inclusion. Articles were screened for relevance and theme categorization and then divided into 6 themes: clinic redesign, curriculum development, evaluating resident practice/performance, teaching methods, program evaluation, and faculty development. Once a theme was assigned, data extraction and quality assessment using the Medical Education Research Study Quality Instrument (MERSQI) score were completed. Results A total of 967 potentially relevant articles were discovered; of those, 182 were deemed relevant and underwent full review. Most articles fell into curriculum development and clinic redesign themes. The majority of included studies were from a single institution, used nonstandardized tools, and assessed outcomes at the satisfaction or knowledge/attitude/skills levels. Few studies showed behavioral changes or patient-level outcomes. Conclusions While a rich diversity of educational innovations have occurred since the 2009 revision of the ACGME Program Requirements in Internal Medicine, there is a significant need for multi-institution studies and higher-level assessment.

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Chronic kidney disease management in an academic internal medicine clinic

Abstract: Chronic kidney disease remains under-recognized and undertreated despite well-publicized guidelines and widespread use of routine eGFR reporting.

Cited by 6 publications

References 28 publications

Implementation of a CKD Checklist for Primary Care Providers

Implementation of a CKD Checklist for Primary Care Providers

Delayed Administration of Suramin Attenuates the Progression of Renal Fibrosis in Obstructive Nephropathy

A Decade of Teaching and Learning in Internal Medicine Ambulatory Education: A Scoping Review

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