title: Barriers to successful care for chronic kidney disease.
abstract: 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.
authors.affiliation: Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL, USA. olenz@med.miami.edu
authors.forename: Oliver
authors.initials: O
authors.lastname: Lenz
authors.forename: Durga P
authors.initials: DP
authors.lastname: Mekala
authors.forename: Daniel V
authors.initials: DV
authors.lastname: Patel
authors.forename: Alessia
authors.initials: A
authors.lastname: Fornoni
authors.forename: David
authors.initials: D
authors.lastname: Metz
authors.forename: David
authors.initials: D
authors.lastname: Roth
mesh_terms: 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