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April 14, 2023

The need for increased awareness of kidney guidelines and treatments among family physicians

A recent analysis shows that more effort may be needed to inform and support family physicians in helping to identify kidney patients at high risk of kidney failure, and to offer these patients appropriate treatment options early on to delay disease progression.

Only some people with chronic kidney disease (CKD) will go on to experience kidney failure, but early identification and treatment of these high-risk patients is critical for delaying when kidney failure occurs. However, most kidney patients are treated by family physicians, who may not be aware of current CKD treatment guidelines. For example, a tool called the Kidney Failure Risk Equation (KFRE) can be used by doctors to understand a person’s personal risk of kidney failure in 2 or 5 years – if someone is deemed high-risk, more aggressive treatment to delay disease progression can be provided.

Janet Yuen et al. sought to understand how many kidney patients at high-risk of serious disease progression are receiving appropriate treatments through their family physician. Using a nation-wide database, they identified 11,035 Canadians living with CKD – 83% of whom were at low risk of progressing to kidney failure, 10.3% at intermediate risk, and 6.7% at high risk. Among intermediate- and high-risk individuals, only 56% were on an ACEI/ARB (a medication useful for treating CKD), 65% had a recent blood pressure measurement within target, and only 30% had received a nephrology referral. Notably, a SGLT2 inhibitor – which is one of the best medications used to delay CKD progression – was used in 12% or less in each risk group.

These results, the authors say, emphasize the need to ensure that family physicians are more aware of tools like the KFRE, which help identify high-risk patients, and are aware of the most recent treatment guidelines and interventions to delay disease progression in high-risk patients.

Risk of CKD Progression and Quality-of-Care Indicators in the Primary Care Setting

Yuen J, Harasemiw O, Singer A, Bello A, Ronksley PE, Bohm C, Drummond N, Tangri N

American Journal of Kidney Diseases