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Open Access Highly Accessed Research article

Primary care physicians’ familiarity, beliefs, and perceived barriers to practice guidelines in non-diabetic CKD: a survey study

Khaled Abdel-Kader1*, Raquel C Greer23, L Ebony Boulware4 and Mark L Unruh5

Author Affiliations

1 Division of Nephrology and Hypertension, Vanderbilt University, 1161 21st Ave. S., MCN S-3223, Nashville, TN 37232, USA

2 Division of General Internal Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street, Suite 2-600, Baltimore, MD 21287, USA

3 Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA

4 Division of General Internal Medicine, Duke University School of Medicine, DUMC 104427, Durham, NC 27710, USA

5 Division of Nephrology, University of New Mexico, DoIM MSC10-5550, Albuquerque, New Mexico 87131, USA

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BMC Nephrology 2014, 15:64  doi:10.1186/1471-2369-15-64

Published: 22 April 2014

Abstract

Background

Most non-dialysis dependent chronic kidney disease (CKD) patients are cared for by their primary care physicians (PCPs). Studies suggest many CKD patients receive suboptimal care. Recently, CKD clinical practice guidelines were updated with additional emphasis on albuminuria.

Methods

We performed an internet-based, cross-sectional survey of active PCPs in the United States using the American Medical Association Physician Masterfile. We explored CKD guideline familiarity, self-reported practice behaviors, and attitudinal and external barriers to implementing guideline recommendations, including albuminuria testing.

Results

Of 12,034 PCPs targeted, 848 opened a study email, 165 (19.5%) responded. Most respondents (88%) spent ≥50% of their time in clinical care. Respondents were generally in private practice (46%). Most PCPs (96%) felt that eGFR values were helpful. Approximately, 75% and 91% of PCPs reported testing for albuminuria in non-diabetic hypertensive patients with an eGFR > 60 ml/min/1.73 m2 and < 60 ml/min/1.73 m2, respectively. Barriers to albuminuria testing included a lack of effect on management, limited time, and the perceived absence of guidelines recommending testing. While PCPs expressed high levels of agreement with the definition of CKD, 30% were concerned with overdiagnosis in older adults with an eGFR in the CKD stage 3a range. Most PCPs felt that angiotensin converting enzyme inhibitor (ACEi)/ angiotensin II receptor blockers (ARBs) improved outcomes in CKD, though agreement was lower with severe vs. moderate albuminuria (78% vs. 85%, respectively, p = 0.03). Many PCPs (51%) reported being unfamiliar with CKD guidelines, but were receptive to systematic interventions to improve their CKD care.

Conclusions

PCPs generally agree with CKD clinical practice guidelines regarding CKD definition and albuminuria testing. However, future interventions are necessary to improve PCPs’ familiarity with CKD guidelines, overcome barriers to albuminuria testing and, assist PCPs in targeting ACEi/ARBs to the patients most likely to benefit.

Keywords:
Chronic kidney disease; Primary care physicians; Survey; Estimate glomerular filtration rate; Albuminuria; Angiotensin converting enzyme inhibitors; Angiotensin II receptor blockers; Barriers