Care for Chronic Kidney Disease Varies Across VA Facilities

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Findings observed for veterans with diabetes and concomitant chronic kidney disease
Findings observed for veterans with diabetes and concomitant chronic kidney disease

(HealthDay News) -- For veterans with diabetes and concomitant chronic kidney disease (CKD), CKD care, including ordering laboratory tests and scheduling nephrology referrals, varies considerably by facility, according to a study published online in the Clinical Journal of the American Society of Nephrology.

Sankar D. Navaneethan, MD, MSPH, from the Selzman Institute for Kidney Health in Houston, and colleagues studied the proportion of 281,223 patients with diabetes and concomitant CKD receiving recommended core measures in 130 facilities across the Veterans Affairs Health Care System.

The researchers found that of the patients with estimated glomerular filtration rate (eGFR) 30 to 59 mL/min/1.73 m², 37, 74, 66, 85, and 47% received recommended core measures for urine albumin-to-creatinine ratio/urine protein-to-creatinine ratio, hemoglobin measurement, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker prescription, statin prescription, and achieving blood pressure <140/90 mm Hg; 13% met all outcome measures. The adjusted median rate ratios quantifying the degree to which care varied for similar patients receiving care at two facilities were 5.2, 2.4, 1.3, 1.2, 1.4, and 4.1, respectively, with >1.2 as substantial variation. In an analysis restricted to patients with eGFR 15 to 29 mL/min/1.73 m², the median rate ratios were qualitatively similar.

"There are ongoing efforts at a national level to improve CKD care, and our results point out potential areas where additional efforts and programs could be implemented to address practice-level variations noted among VA facilities," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

References

Navaneethan SD, Akeroyd JM, Ramsey D, Ahmed ST, et al. Facility-Level Variations in Kidney Disease Care among Veterans with Diabetes and CKD. Clin J Am Soc Nephrol. November 2018, CJN.03830318; DOI: 10.2215/CJN.03830318

Woodell TB and Rifkin DE. Still Asking “Which Rate Is Right?” Years Later. Clin J Am Soc Nephrol. November 2018, CJN.12371018; DOI:10.2215/CJN.12371018

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