title: Cardiovascular risk management in chronic kidney disease in general practice (the AusHEART study).
abstract: BACKGROUND
  Chronic kidney disease (CKD) is common and increasing in prevalence. Adverse outcomes of CKD can be prevented through early detection and treatment. There is limited data on the awareness of CKD and the quality of care offered to patients with CKD in the primary care setting. The objectives of this study were to assess the prevalence, general practitioner (GP) awareness and extent of current evidence-practice gaps in the management of CKD in Australian primary care.
  
  
  METHODS
  The Australian Hypertension and Absolute Risk Study (AusHEART) was a nationally representative, cluster stratified, cross-sectional survey among 322 GPs. Each GP was asked to provide data for 15-20 consecutive patients (age ≥ 55 years) who presented between April and June, 2008. The main outcome measures were CKD prevalence based on proteinuria and decreased estimated glomerular filtration rate. Evidence-practice gaps in management of patients with CKD were identified.
  
  
  RESULTS
  Among a total of 4966 patients with kidney function test data, 1845 (37%) had abnormal kidney function. Of the 1312 patients with abnormal kidney function known to the GP at the time of visit, only 235 were correctly identified as having CKD. GPs under-estimated cardiovascular (CV) risks in patients with CKD when compared with the prevailing guidelines at the time of survey and the recent national guidelines, particularly in later stages of CKD. Among CKD patients not prescribed blood pressure-lowering agents or lipid-lowering agents, treatment was indicated as per relevant guidelines in 51 and 46%, respectively. For CKD patients who were already prescribed blood pressure-lowering and lipid-lowering agents, 61 and 50%, respectively, did not meet the treatment targets recommended by the relevant guidelines.
  
  
  CONCLUSIONS
  CKD is common, significantly under-recognized and under-treated in primary care. Effort to increase awareness and provide opportunities for improved screening and assessment should improve the management and outcome of these patients at high risk of CV disease.
authors: The George Institute for Global Health, Sydney, Australia.
authors: Mona
authors: M
authors: Razavian
authors: Emma L
authors: EL
authors: Heeley
authors: Vlado
authors: V
authors: Perkovic
authors: Sophia
authors: S
authors: Zoungas
authors: Andrew
authors: A
authors: Weekes
authors: Anushka A
authors: AA
authors: Patel
authors: Craig S
authors: CS
authors: Anderson
authors: John P
authors: JP
authors: Chalmers
authors: Alan
authors: A
authors: Cass
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D058006:General Practice; D005919:Glomerular Filtration Rate; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D010818:Practice Patterns, Physicians' / Q000592:standards*; D015995:Prevalence; D011379:Prognosis; D012308:Risk Management