title: Management of chronic kidney disease in Taiwan: room for quality improvement.
abstract: 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.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan.
authors.forename: Hsin-Wei
authors.initials: HW
authors.lastname: Kuo
authors.forename: Shang-Shyue
authors.initials: SS
authors.lastname: Tsai
authors.forename: Mao-Meng
authors.initials: MM
authors.lastname: Tiao
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Liu
authors.forename: Chun-Yuh
authors.initials: CY
authors.lastname: Yang
mesh_terms: 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
chemical_list: D000959:Antihypertensive Agents; D008055:Lipids; D002118:Calcium