Barriers to successful care for chronic kidney disease.
BACKGROUND
The National Kidney Foundation has formulated clinical practice guidelines for patients with chronic kidney disease (K/DOQI). However, little is know about how many patients actually achieve these goals in a dedicated clinic for chronic kidney disease.


METHODS
We performed a cross-sectional analysis of 198 patients with an estimated glomerular filtration rate of less than 30 ml/min/1.73 m2 and determined whether K/DOQI goals were met for calcium, phosphate, calcium-phosphate product, parathyroid hormone, albumin, bicarbonate, hemoglobin, lipids, and blood pressure.


RESULTS
We found that only a small number of patients achieved K/DOQI targets. Recent referral to the nephrologist, failure to attend scheduled clinic appointments, African American ethnicity, diabetes, and advanced renal failure were significant predictors of low achievement of K/DOQI goals.


CONCLUSIONS
We conclude that raising awareness of chronic kidney disease and K/DOQI goals among primary care providers, early referral to a nephrologist, the exploration of socioeconomic barriers and cultural differences, and both patient and physician education are critical to improve CKD care in patients with Stage 4 and 5 CKD.
Lenz
Oliver
O
Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL, USA. olenz@med.miami.edu
Mekala
Durga P
DP
Patel
Daniel V
DV
Fornoni
Alessia
A
Metz
David
D
Roth
David
D
D001741:Black or African American; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D005919:Glomerular Filtration Rate; D006040:Goals; D019983:Guideline Adherence; D006801:Humans; D007674:Kidney Diseases / Q000208:ethnology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000628:therapy; D009398:Nephrology; D009819:Office Visits; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012017:Referral and Consultation