Patients with chronic kidney disease (CKD) in the United States experience “substantial and persistent gaps,” in their care, according to Sri Lekha Tummalapalli, MD, MBA, of the University of California, San Francisco, and colleagues. The team reported new national data online ahead of print in the Clinical Journal of the American Society of Nephrology.

Uncontrolled hypertension of more 130/80 mm Hg has not improved over time, affecting 46% of CKD patients during the years 2006 to 2008 and 48% during 2012 to 2014, according to outpatient records from the National Ambulatory Medical Care Survey (NAMCS). Use of an ACE inhibitor or angiotensin receptor blocker (ACEi/ARB) actually declined from 45% in 2006 to 2008 to 36% in 2012 to 2014.

In addition, 40% of patients diagnosed with CKD had uncontrolled diabetes (hemoglobin A1c higher than 7%) during the period 2012 to 2014, despite primary care and specialty physician awareness and Kidney Disease Outcomes Quality Initiative (KDOQI) recommendations.

Statin use remained low and unchanged, from 29% in 2006 to 2008 to 31% in 2012 to 2014. Yet Kidney Disease Improving Global Outcomes (KDIGO) lipid guidelines encourage statin therapy for CKD patients 50 years and older.  

Use of nonsteroidal anti-inflammatory drugs (NSAIDs) increased from 2% in 2006 to 2008 to 4% in 2012 to 2014, despite a Choosing Wisely recommendation to avoid it.

The new study findings largely agree with previous research on the civilian CKD population examining trends during earlier and concurrent periods, according to the investigators.

“There is a national conversation happening right now about kidney disease. National professional organizations, government, and insurance are coalescing to improve care models for kidney disease,” Dr Tummalapalli stated in news release from the American Society of Nephrology. “Preventing kidney failure and decreasing the risk of other complications, such as heart disease, starts at early stages of CKD. Our research highlights the current gaps in care.”

Towards that goal, on July 10, President Donald J. Trump signed an executive order to launch Advancing American Kidney Health, a new initiative to improve the lives of Americans suffering from kidney disease.

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References

Lekha Tummalapalli S, Powe NR, and Keyhani S. Trends in Quality of Care for Patients with CKD in the United States. Clin J Am Soc Nephrol. doi:10.2215/CJN.00060116

Study Reveals Substantial and Persistent Gaps in Quality of Care for Patients with Chronic Kidney Disease [news release]. American Society of Nephrology; July 11, 2019.

HHS Launches President Trump’s ‘Advancing American Kidney Health’ Initiative [news release]. Health and Human Services; July 10 2019.

KDIGO Clinical Practice Guideline for Lipid Management in Chronic Kidney Disease. https://kdigo.org/wp-content/uploads/2017/02/KDIGO-2013-Lipids-Guideline-English.pdf Accessed on July 11, 2019.