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Many older adults with chronic kidney
don't receive recommended medical care
Newswise — Many older adults with
chronic kidney disease (CKD) don't receive the screening tests and
basic preventive care routinely recommended for patients with this
condition, reports a study in the October Journal of the American
Society of Nephrology.
Led by Dr. Annamaria T. Kausz of
Tufts-New England Medical Center, Boston, the researchers collected
data on nearly 2,500 elderly Medicare recipients with CKD who
eventually required dialysis to replace lost kidney function.
Records were reviewed to evaluate the patients' routine medical care
in the two years before they started dialysis.
The results showed important
shortcomings in general health and CKD care.
Many diabetic patients
with CKD did not receive routine tests to detect other diabetes
complications—one-third had no eye examinations during the 2-year
study period, while another one-third did not have their cholesterol
and blood lipid levels checked. One-fourth of diabetic CKD patients
did not undergo hemoglobin A1C testing to assess long-term diabetes
Rates of other key tests and preventive measures for CKD patients
were low as well, including screening tests for various types of
cancer. Just half of the CKD patients underwent recommended tests
for anemia, while only 15 percent had testing of parathyroid hormone
levels. Patients with CKD were actually less likely than non-CKD
patients to receive vaccinations for influenza and pneumococcal
Overall, medical care for patients with CKD was similar to that for
a comparison group of approximately 1 million Medicare patients
without CKD. It wasn't that health care was "neglected" for patients
with CKD; rather, their suboptimal care reflected a "generalized
lack of implementation of recommended health care measures" for
elderly Medicare recipients. Since both groups were eligible for
Medicare, the shortcomings in CKD care did not reflect problems with
health care access.
Most CKD patients did not make
more than two visits to a nephrologist (kidney specialist) during
the two years before starting dialysis. Patients who did make
regular nephrologist visits were more likely to receive recommended
tests and treatments.
Patients with CKD have gradual,
irreversible declines in kidney function. Affecting nearly 10
million Americans, CKD brings an increased risk of many different
health problems, including cardiovascular disease, cancer, and
infections. The National Kidney Foundation published extensive
recommendations for the medical care of CKD patients in 2002. The
new study is the first to assess general medical care for CKD on a
The reasons for the low rates of testing and preventive treatments
are unknown—doctors may be unaware of the recommendations for CKD,
or patients may lack a single physician coordinating their medical
care. "Recognition of CKD by the treating physician and timely
nephrology referral are essential components for providing adequate
care for CKD patients," Dr. Kausz and coauthors write. Ongoing
efforts by the National Kidney Foundation should lead to increased
recognition and improved care for CKD. Meanwhile, more research is
needed to determine which types of routine medical care can have the
greatest impact on the health of CKD patients.
The ASN is a not-for-profit organization of 9,000 physicians and
scientists dedicated to the study of nephrology and committed to
providing a forum for the promulgation of information regarding the
latest research and clinical findings on kidney diseases.