Care of elderly patients with chronic kidney disease.
BACKGROUND
Providing optimal care to the growing number of chronic kidney disease (CKD) patients remains a significant problem in the United States. There is little known about the care of elderly CKD patients by primary care physicians as well as nephrologists.


METHODS
We performed a retrospective study of 377 elderly male CKD (serum creatinine >1.4 mg/dl on 2 separate occasions 3 months apart) patients referred to the Nephrology Clinic at the Buffalo Veterans Administration Medical Center between 1999 and 2002 to see if the pattern of care changed during this time.


RESULTS
The mean age of the patients was 75.9 years. Eighty-four percent were Caucasian, 15% were African-American, and 1% were of other race. Etiology of CKD included hypertensive nephrosclerosis (49%), diabetic nephropathy (23%), renovascular disease (18%), and others (10%). Sixty-five percent of patients had estimated glomerular filtration rate (eGFR) >30 ml/min. Overall angiotensin converting enzyme inhibitor (ACEI) was used in 51% of patients with CKD, and in 63% of patients with diabetic nephropathy. Twenty percent of patients had a hemoglobin <11 g/dl, darbepoietin/epogen was used in 31% of these patients. Screening for kidney related tests were done infrequently while lipid profile and hemoglobin A1C were done in the majority of patients because of clinical reminders in the VA computerized patient record system (CPRS).


CONCLUSIONS
These results emphasize the need for increased education of primary care physicians and nephrologists to improve the care of elderly CKD patients. Although there was a trend towards earlier referral, care did not change significantly between years 1999 and 2002.
Arora
Pradeep
P
Division of Nephrology, VAMC, State University of NY at Buffalo, Buffalo, NY 14215, USA. pradeep.arora@med.va.gov
Mustafa
Reem A
RA
Karam
Jyotheen
J
Khalil
Patricia
P
Wilding
Greg
G
Ranjan
Rajiv
R
Lohr
James
J
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015897:Comorbidity; D019468:Disease Management; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D007677:Kidney Function Tests / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D010821:Physicians, Family / Q000193:education; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000639:trends; D012017:Referral and Consultation / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies