title: A cluster randomized trial of an enhanced eGFR prompt in chronic kidney disease.
abstract: OBJECTIVE
  Despite reporting estimated GFR (eGFR), use of evidence-based interventions in CKD remains suboptimal. This study sought to determine the effect of an enhanced eGFR laboratory prompt containing specific management recommendations, compared with standard eGFR reporting in CKD.
  
  
  METHODS
  A cluster randomized trial of a standard or enhanced eGFR laboratory prompt was performed in 93 primary care practices in Alberta, Canada. Although all adult patients with CKD (eGFR <60 ml/min per 1.73 m(2)) were included, medication data were only available for elderly patients (aged ≥66 years). The primary outcome, the proportion of patients with diabetes or proteinuria receiving an angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB), was assessed in elderly CKD patients.
  
  
  RESULTS
  There were 5444 elderly CKD patients with diabetes or proteinuria who were eligible for primary outcome assessment, irrespective of baseline ACEi/ARB use. ACEi/ARB use in the subsequent year was 77.1% and 76.9% in the standard and enhanced prompt groups, respectively. In the subgroup of elderly patients with an eGFR <30 ml/min per 1.73 m(2), ACEi/ARB use was higher in the enhanced prompt group. Among 22,092 CKD patients, there was no difference in the likelihood of a composite clinical outcome (death, ESRD, doubling of serum creatinine, or hospitalization for myocardial infarction, heart failure, or stroke) over a median of 2.1 years.
  
  
  CONCLUSIONS
  In elderly patients with CKD and an indication for ACEi/ARB, an enhanced laboratory prompt did not increase use of these medications.
authors.affiliation: Department of Medicine, University of Calgary, Alberta, Canada. Braden.Manns@albertahealthservices.ca
authors.forename: Braden
authors.initials: B
authors.lastname: Manns
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.forename: Bruce
authors.initials: B
authors.lastname: Culleton
authors.forename: Peter
authors.initials: P
authors.lastname: Faris
authors.forename: Kevin
authors.initials: K
authors.lastname: McLaughlin
authors.forename: Rick
authors.initials: R
authors.lastname: Chin
authors.forename: Katherine
authors.initials: K
authors.lastname: Gooch
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
authors.forename: Ken
authors.initials: K
authors.lastname: Taub
authors.forename: Laurel
authors.initials: L
authors.lastname: Thorlacius
authors.forename: Richard
authors.initials: R
authors.lastname: Krause
authors.forename: Monica
authors.initials: M
authors.lastname: Kearns
authors.forename: Brenda
authors.initials: B
authors.lastname: Hemmelgarn
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D016000:Cluster Analysis; D003404:Creatinine / Q000097:blood; D020000:Decision Support Systems, Clinical; D003928:Diabetic Nephropathies / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D011307:Drug Prescriptions; D005919:Glomerular Filtration Rate / Q000187:drug effects; D019983:Guideline Adherence; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D007674:Kidney Diseases / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011379:Prognosis; D011507:Proteinuria / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D012044:Regression Analysis; D017010:Reminder Systems; D013997:Time Factors
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D003404:Creatinine