Reporting of estimated glomerular filtration rate: effect on physician recognition of chronic kidney disease and prescribing practices for elderly hospitalized patients.
BACKGROUND
Physician recognition of chronic kidney disease (CKD) in elderly patients has been noted to be poor. These patients are at increased risk of medication dosing errors and acute renal failure.


OBJECTIVE
To investigate the effect of reporting estimated glomerular filtration rate (GFR) of elderly hospitalized patients on physician recognition of CKD and physician prescribing behaviors.


METHODS
A retrospective combined with a prospective medical record review project.


METHODS
A large academic medical center.


METHODS
Patients included were 65 years of age or older and had creatinine values within the normal laboratory range (< 1.6 mg/dL).


METHODS
Reporting a calculated estimate of GFR to physicians.


METHODS
Rates of recognition of CKD were examined before and after the intervention. The effects of the intervention on prescription of renal-dosed antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDS) and cyclooxygenase- 2 inhibitors (COX-2) at hospital discharge were assessed.


RESULTS
A total of 260 and 198 patients were included before and after the intervention, respectively. Recognition of chronic kidney disease was low in both groups but demonstrated a significant increase following reporting of estimated GFR (3.9% to 12.6%, P < .001). Reporting of GFR was not associated with a significant decrease in prescription of NSAID/COX-2 medications or increased rates of correct dosing of antibiotics (P = .10 and P = .81, respectively).


CONCLUSIONS
Although reporting of estimated GFR was associated with improved physician recognition of CKD in elderly hospitalized patients, it did not lead to a change in physician prescribing. More extensive interventions are necessary to increase recognition and decrease medication dosing errors.
Quartarolo
Jennifer M
JM
Department of Medicine, University of California at San Diego, San Diego, California, USA. jquartarolo@ucsd.edu
Thoelke
Mark
M
Schafers
Stephen J
SJ
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000188:drug therapy; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D011446:Prospective Studies; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003404:Creatinine