Management of patients with chronic kidney disease: a French medical centre database analysis

Matthieu Ariza; Steven Martin; Mikaël Dusenne; David Darmon; Matthieu Schuers

doi:10.1093/fampra/cmad004

Management of patients with chronic kidney disease: a French medical centre database analysis

Fam Pract. 2023 Jan 27:cmad004. doi: 10.1093/fampra/cmad004. Online ahead of print.

Authors

Matthieu Ariza¹, Steven Martin², Mikaël Dusenne³, David Darmon⁴, Matthieu Schuers⁵

Affiliations

¹ University of Picardy Jules Verne, Department of General Medicine, Amiens, France.
² University of Picardy Jules Verne, Amiens, France.
³ University Hospital Centre of Rouen, Rouen, France.
⁴ University of Côte d'Azur, RETINES, Department of Teaching and Research in General Medicine, Nice, France.
⁵ Department of General Medicine of Rouen, University of Rouen, Rouen, France.

PMID: 36708191
DOI: 10.1093/fampra/cmad004

Abstract

Objective(s): Chronic kidney disease (CKD) is an insidious disease that requires early nephroprotective measures to delay progression to end-stage kidney disease. The objective of this study was to describe the management of patients with CKD in primary care, including clinical and biological monitoring and prescribed treatments. A retrospective, single-centre study was conducted on adult patients who were treated in the Maison de Neufchâtel (France) between 2012 and 2017 at least once a year. The inclusion criteria were 2 estimated glomerular filtration rate (eGFR) measurements <60 mL/min more than 3 months apart. Two subgroups were constituted according to whether CKD was coded in the electronic medical records (EMRs).

Results: A total of 291 (6.7%, CI95% 5.9-7.4) patients with CKD were included. The mean eGFR was 51.0 ± 16.4 mL/min. Hypertension was the most frequent health problem reported (n = 93, 32%). Nephrotective agents were prescribed in 194 (66.7%) patients, non-steroidal anti-inflammatory drugs (NSAIDs) in 22 (8%) patients, and proton-pump inhibitors (PPIs) in 147 (47%) patients. CKD coding in EMRs was associated with dosage of natraemia (n = 34, 100%, P < 0.01), albuminuria (n = 20, 58%, P < 0.01), vitamin D (n = 14, 41%, P < 0.001), and phosphorus (n = 11, 32%, P < 0.001). Eighty-one patients (31.5%) with low eGFR without an entered code for CKD were prescribed an albuminuria dosage. Clinical monitoring could not be analysed due to poor coding.

Conclusion: This pilot study reinforces the hypothesis that CKD is underscreened and undermanaged. More systematic coding of medical information in EMRs and further studies on medical centre databases should improve primary care practices.

Keywords: chronic; critical pathways; database; diagnostic; primary health care; renal insufficiency.

Plain language summary

Chronic kidney disease (CKD) is an insidious disease that requires early protective measures to delay progression to end-stage kidney disease. The aim of this study was to describe the management of patients with CKD in primary care. A study was conducted in France by analysing the medical records of adult patients between 2012 and 2017. Of 4,370 patients, 291 (6.7%) had CKD. Hypertension was the main associated medical history (32%) and was also known to be one of the main risk factors for CKD. Ninety-seven patients (33%) did not receive any medication indicated to protect the kidneys. Kidney-toxic drugs were widely prescribed, including PPIs in 47% of patients and NSAIDs in 8% of patients. Patients with a CKD note in their medical record had closer biological monitoring. This pilot study reinforces the hypothesis that CKD is underscreened and undermanaged. The coding of information in primary care and further studies on these databases should improve the practice of general practice.