title: Electronic records suggest suboptimal management of chronic kidney disease in general practice.
abstract: OBJECTIVE
  To examine electronic records of GP management of chronic kidney disease.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Thirteen general practices.
  
  
  METHODS
  Fifteen thousand four hundred and fiftteen active patients aged 50 years and over.
  
  
  METHODS
  Recorded estimated glomerular filtration rate (eGFR) and diabetes, and rate of prescribing of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACE/ARBs).
  
  
  RESULTS
  Six thousand and fifty-nine (39%) patients had hypertension and 1859 (12%), diabetes. Two thousand six hundred and eighty-nine (17%) patients were recorded with eGFR < 60 mL min(-1) (1.73 m(2) )(-1) , while 3344 (22%) did not have an eGFR result recorded. Hypertension, diabetes and eGFR <60 mL min(-1) (1.73 m(2) )(-1 ) were shown to be significantly related to prescribing of ACE/ARBs; however, 31% of known diabetics and 23% of diabetics with an eGFR < 60 mL min(-1) (1.73 m(2) )(-1 ) are not recorded as receiving ACE or ARB therapy. Forty-two per cent of patients with eGFR < 60 mL min(-1) (1.73 m(2) )(-1) , are also not recorded as receiving ACE or ARB therapy. There was a 23% variation in the rates of prescribing of ACE/ARBs by practice for patients with diabetes and eGFR < 60 mL min(-1) (1.73 m(2) )(-1) .
  
  
  CONCLUSIONS
  The overall recording of eGFR and the recorded prescribing of ACE or ARB therapy in known diabetics and patients with eGFR < 60 mL min(-1) (1.73 m(2) )(-1) appear suboptimal. Also, the variations in prescribing between practices require further investigation.
authors: Murrumbidgee Medicare Local Limited, Wagga Wagga, New South Wales, Australia. louis.pilotto@mmll.org.au
authors: Louis S J
authors: LS
authors: Pilotto
authors: Partick A
authors: PA
authors: Ball
authors: Jane M
authors: JM
authors: Smithard
authors: David R J
authors: DR
authors: Kennedy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D054869:Clinical Audit / Q000379:methods; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology; D057286:Electronic Health Records; D005260:Female; D058006:General Practice / Q000592:standards* / Q000706:statistics & numerical data; D005919:Glomerular Filtration Rate / Q000502:physiology; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors