Management of chronic kidney disease in Taiwan: room for quality improvement.
BACKGROUND
End-stage renal disease is epidemic in Taiwan. Although early intervention in chronic kidney disease (CKD) has proven to be effective in modifying its clinical course, little is known about the quality and trend of CKD care in Taiwan.


METHODS
From a nationally representative database of 200,000 individuals, CKD patients were identified by diagnostic codes, and their medical interventions were extracted from service claims. The predictors for care delivery were analyzed in a logistic regression model.


RESULTS
Of the 7,740 patients with CKD, only 54.8% had follow-up of renal function. Tests for anemia, calcium/ phosphorus and lipid profile were performed in 34.5%, 5.2% and 40.9% of patients, respectively. Most hypertensive CKD patients have used antihypertensive agents, but only 58.1% of them received angiotensinconverting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). Of CKD patients with diabetes, less than half had glycosylated hemoglobin measured, and only 49.7% received ACEIs/ARBs. We observed an encouraging trend in the use of ACEIs/ ARBs and in most aspects of laboratory monitoring.


CONCLUSIONS
Management of CKD patients is suboptimal, and lack of awareness is common. Further work is needed to evaluate the impact of educational initiatives and multidisciplinary teams on outcomes in CKD patients.
Kuo
Hsin-Wei
HW
Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan.
Tsai
Shang-Shyue
SS
Tiao
Mao-Meng
MM
Liu
Yi-Chun
YC
Yang
Chun-Yuh
CY
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002118:Calcium / Q000097:blood; D002908:Chronic Disease; D003695:Delivery of Health Care / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D007674:Kidney Diseases / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000517:prevention & control / Q000628:therapy; D008055:Lipids / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care / Q000639:trends*; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology
D000959:Antihypertensive Agents; D008055:Lipids; D002118:Calcium