Knowledge of physicians on chronic kidney disease and their attitudes towards referral, in two cities of Cameroon: a cross-sectional study

Abstract

BackgroundChronic kidney disease (CKD) is frequently unrecognized by non-nephrology physicians. There is an ongoing governmental program to create hemodialysis centers in the ten regions of Cameroon, where a previous study reported high levels of late referral to nephrologists. We aimed to assess the knowledge of physicians on CKD and their attitudes regarding referral.MethodsA questionnaire based on the Kidney Disease Outcome Quality Initiative Guidelines of 2002 was self-administered to general practitioners and non-nephrology specialists working in two Cameroon cities that have hemodialysis centers (Douala and Bamenda).ResultsOf the 174 general practitioners and non-nephrology specialists approached, 114 (65.5 %) returned answered questionnaires. Only 58.8 % of doctors identified the correct definition of CKD. Most physicians were aware of the major risk factors of CKD (hypertension, 97.4 % and diabetes mellitus, 95.6 %). Most physicians were also aware of complications such as anemia (93.0 %), hypertension (90.4 %), uremia (85.1 %) and hyperkalemia (85.1 %). Only 44 % knew that CKD had five stages, with general practitioners 3.4 times more likely to know than specialists (p = 0.004). Even though 61.4 % of the physicians knew that the estimated glomerular filtration rate was the appropriate clinical means to diagnose CKD, 12.7 % would use serum creatinine alone for diagnosis. Also, up to 21.9 % of physicians would refer at late stage.ConclusionGeneral practitioners and non-nephrology specialists lack general knowledge on CKD, especially on the definition and staging; they also have inadequate attitudes with regards to diagnosis and referral to the nephrologists. Educational efforts are warranted to improve on physicians’ knowledge and skills on CKD in Cameroon.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-016-1845-5) contains supplementary material, which is available to authorized users.

Doctors’ knowledge and practices regarding chronic kidney disease at a tertiary care hospital

“…The majority recognized diabetes mellitus, hypertension, renal stone disease and chronic glomerulonephritis as being risk factors for CKD. This was similar to results noted in a study in Cameroon [46], as well as in a web-based survey in the US [49]. Several studies have shown an increased risk for CKD among individuals with diabetes, hypertension, autoimmune diseases, urinary tract infections, stone diseases, and older age, among others [50].…”

“…The potential complications of CKD were identified by a majority of the respondents, but fewer attending doctors (66.7%) identified cardiovascular disease as a complication of CKD. The most commonly identified complication was anemia, similar to other studies [38,45,46,49].…”

“…Timely medical intervention which can slow progression of CKD and prevent ESRD has been advocate, since the cost of ESRD programmes is prohibitive, and the quality of life of patients on dialysis is poor [45]. One way of raising physicians' awareness on staging CKD is to recommend that laboratories should systematically calculate and even stage the eGFR based on the serum creatinine results [46]. Such a strategy has been shown to greatly increase the number of referrals to nephrologists [47,48].…”

How well are general practitioners informed about chronic kidney disease?

“…Chronic kidney disease (CKD) is a major public health issue [1], and its prevalence is dramatically increasing worldwide. Moreover, CKD patients have higher cardiovascular risk and mortality rates in comparison to the general population [2][3].…”

“…In fact, many patients with CKD will require renal replacement therapy, which represents an economic burden for health systems [2]. Prevention, early detection and appropriate care are cost-effective strategies, especially in resource-limited countries, where access to renal therapies is often conditioned by nancial constraints.…”