Gap in care found for patients with chronic kidney disease: study

October 24, 2019

Millions of Canadians living with chronic kidney disease (CKD) may be going without critical testing from their primary care practitioners that would give them a good idea of the severity of the disease so they could intervene earlier with more appropriate care, according to a new study.

"It's a problem," said Aminu Bello, an associate professor of medicine at the University of Alberta and lead author of the study. "It's not that primary care physicians are negligent, but this is an area we need to focus on because it's critical."

A team of researchers across Canada, the United States and the United Kingdom examined the records of more than 46,000 Canadian patients with CKD. It found that within six months of being diagnosed, less than 20 per cent of patients received a urine albumin test--used to assess the severity of the kidney disease and the risk of developing adverse health outcomes such as end-stage kidney failure, heart disease and strokes.

It's unclear why urine albumin testing was not routinely conducted by primary care practitioners in the study. The test indicates the severity of the damage in the kidney--the more albumin is found in the urine, the higher the chance that people will lose kidney function over time, amplifying the risk of cardiovascular diseases such as heart attacks and strokes.

It's estimated that 10 to 12 per cent of Canadians are living with chronic kidney disease, with more than 90 per cent of those patients being cared for by primary care practitioners.

According to Bello, primary care practitioners did meet most other key benchmarks for managing chronic kidney disease in their patients.

The study showed that more than 75 per cent of the time, primary care physicians achieved the recommended targets when it came to checking patients' blood pressure, ensuring they were at the proper target for blood pressure control and giving them appropriate medication when required.

Bello hopes that addressing the gap in care will mean more Canadians can avoid end-stage kidney disease, benefiting both their own lives and Canada's health-care system.

According to most recent estimates by the Canadian Organ Replacement Registry, about 39,000 Canadians are living with end-stage kidney failure and are on dialysis or have had a transplant. It costs about $100,000 a year per person to provide dialysis. The costs of providing care to people living with end-stage kidney failure account for about two to three per cent of the total health-care budget in most high-income countries like Canada.

"We want to ensure that Canadians with mild or moderate kidney disease get really high-quality care early on, so we can prevent them ending up on dialysis or getting to the stage where they require a kidney transplant to live," said Bello.

According to Bello, the urine albumin test is covered under Canada's health-care system and is easy to do without requiring any sophisticated equipment. He believes the low adherence to conducting the test may be due to a lack of awareness of current guidelines or a lack of time with patients due to heavy workloads.

A number of initiatives are underway across the country to address the gaps and enhance quality care for patients with CKD. Locally, the Alberta Health Services Kidney Health Strategic Clinical Network has made giving the test a priority to reduce the risk of adverse health outcomes associated with CKD.

"We are very fortunate to be supported by these initiatives to impact kidney care positively in our communities," said Bello."So it's a matter of engagement and making primary care more aware that this test is equally important as checking blood pressure. It's an opportunity to have a dialogue about it because we can do better."
-end-
The study, "Quality of Chronic Kidney Disease Management in Canadian Primary Care," was funded by the Canadian Institutes of Health Research and published in JAMA Network Open.

University of Alberta Faculty of Medicine & Dentistry

Related Blood Pressure Articles from Brightsurf:

Children who take steroids at increased risk for diabetes, high blood pressure, blood clots
Children who take oral steroids to treat asthma or autoimmune diseases have an increased risk of diabetes, high blood pressure, and blood clots, according to Rutgers researchers.

High blood pressure treatment linked to less risk for drop in blood pressure upon standing
Treatment to lower blood pressure did not increase and may decrease the risk of extreme drops in blood pressure upon standing from a sitting position.

Changes in blood pressure control over 2 decades among US adults with high blood pressure
National survey data were used to examine how blood pressure control changed overall among U.S. adults with high blood pressure between 1999-2000 and 2017-2018 and by age, race, insurance type and access to health care.

Transient increase in blood pressure promotes some blood vessel growth
Blood vessels are the body's transportation system, carrying oxygen and nutrients to cells and whisking away waste.

Effect of reducing blood pressure medications on blood pressure control in older adults
Whether the amount of blood pressure medications taken by older adults could be reduced safely and without a significant change in short-term blood pressure control was the objective of this randomized clinical trial that included 534 adults 80 and older.

Brain blood flow sensor discovery could aid treatments for high blood pressure & dementia
A study led by researchers at UCL has discovered the mechanism that allows the brain to monitor its own blood supply, a finding in rats which may help to find new treatments for human conditions including hypertension (high blood pressure) and dementia.

Here's something that will raise your blood pressure
The apelin receptor (APJ) has been presumed to play an important role in the contraction of blood vessels involved in blood pressure regulation.

New strategy for treating high blood pressure
The key to treating blood pressure might lie in people who are 'resistant' to developing high blood pressure even when they eat high salt diets, shows new research published today in Experimental Physiology.

Arm cuff blood pressure measurements may fall short for predicting heart disease risk in some people with resistant high blood pressure
A measurement of central blood pressure in people with difficult-to-treat high blood pressure could help reduce risk of heart disease better than traditional arm cuff readings for some patients, according to preliminary research presented at the American Heart Association's Hypertension 2019 Scientific Sessions.

Heating pads may lower blood pressure in people with high blood pressure when lying down
In people with supine hypertension due to autonomic failure, a condition that increases blood pressure when lying down, overnight heat therapy significantly decreased systolic blood pressure compared to a placebo.

Read More: Blood Pressure News and Blood Pressure Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.