title: Low rates of testing and diagnostic codes usage in a commercial clinical laboratory: evidence for lack of physician awareness of chronic kidney disease.
abstract: Improving outcomes for chronic kidney disease (CKD) requires early identification and recognition by physicians. There are few data on rates of testing or use of diagnostic codes for CKD. A cross-sectional analysis was performed of patients who were older than 40 yr and had one or more laboratory tests between April 1, 2002, and March 31, 2003, at a Laboratory Corporation of America regional laboratory. Objectives were to determine the frequency of testing for serum creatinine; prevalence of CKD, defined as estimated GFR <60 ml/min per 1.73 m2; and sensitivity of diagnostic codes for CKD for patients with and without risk factors for CKD and with or without cardiovascular disease (CVD). Of the 277,111 patients, 19% had serum creatinine measured, compared with 33 and 71% who had measurements of serum glucose and lipids, respectively. Patients with hypertension, diabetes, and age >60 yr were more likely to be tested for serum creatinine with odds ratio (OR; 95% confidence interval) of 2.09 (2.05 to 2.14), 1.22 (1.19 to 1.25), and 1.24 (1.22 to 1.27) respectively. Among patients tested, 30% had CKD. Sensitivity and specificity of kidney disease diagnostic codes compared with CKD defined by estimated GFR <60 ml/min per 1.73 m2 were 11 and 96%, respectively. In patients with hypertension, diabetes, age >60 years, and CVD, rates of testing and sensitivity of diagnostic codes were 53 and 14%, respectively. Low rates of testing for serum creatinine and insensitivity of diagnostic codes for CKD, even in high-risk patients, suggests inadequate physician awareness of CKD and limited utility of administrative databases for identification of patients with CKD.
authors.affiliation: Tufts New England Medical Center, 750 Washington Street, Box 391, Boston, MA 02111, USA. lstevens1@tufts-nemc.org
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Stevens
authors.forename: George
authors.initials: G
authors.lastname: Fares
authors.forename: James
authors.initials: J
authors.lastname: Fleming
authors.forename: David
authors.initials: D
authors.lastname: Martin
authors.forename: Kalyani
authors.initials: K
authors.lastname: Murthy
authors.forename: Jiejing
authors.initials: J
authors.lastname: Qiu
authors.forename: Paul C
authors.initials: PC
authors.lastname: Stark
authors.forename: Katrin
authors.initials: K
authors.lastname: Uhlig
authors.forename: Frederick
authors.initials: F
authors.lastname: Van Lente
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
mesh_terms: D000328:Adult; D000368:Aged; D001774:Blood Chemical Analysis; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis; D002624:Chemistry, Clinical / Q000379:methods*; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D019992:Databases as Topic; D005260:Female; D005919:Glomerular Filtration Rate; D006282:Health Personnel; D006801:Humans; D038801:International Classification of Diseases; D007676:Kidney Failure, Chronic / Q000145:classification* / Q000175:diagnosis*; D007755:Laboratories, Hospital; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D009398:Nephrology / Q000379:methods*; D016017:Odds Ratio; D010820:Physicians; D015995:Prevalence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D003404:Creatinine