ABSTRACT
OBJECTIVES: In hospitalised patients, chronic kidney disease (CKD) is associated with a high risk of morbidity, mortality and drug toxicity. We identified care improvement opportunities in hospitalised patients with kidney disease in a regional hospital. MATERIAL AND METHOD: Clinical audit: 200 patients hospitalised for any reason in Alcañiz Hospital (Spain) were randomly selected. The data sources were laboratory data, clinical history and discharge reports. RIFLE criteria were applied to define kidney function deterioration. As process quality indicators we used: 1) percentage of hospitalised patients with at least one determination of kidney function during admission. 2) percentage of patients who met criteria for CKD and/or kidney function deterioration and who had this diagnosis recorded in clinical progress reports. 3) percentage of patients who met criteria for CKD and/or kidney function deterioration and who had this diagnosis recorded in the discharge report. RESULTS: Mean age was 71.1 (17) years, 42% women, 63% admitted to medical areas and 37% to surgical areas. Some 194 patients had a kidney function determination at admission; however during their stay kidney function was not monitored in 54 patients (27%), especially in surgical areas. CKD diagnosis by analyses prior to admission was available for 50 patients (25%); however this diagnosis figures in the clinical history in 14 of them (28%), and in the discharge report in 17 (34%). Kidney function deterioration was detected in 68 of the 146 patients who had kidney function monitoring during hospitalisation (46.5%). This information was contained in the clinical history in only 50% of cases and in the discharge report in 33.8%. CONCLUSIONS: The incidence of CKD prior to admission and deterioration of kidney function during hospitalisation are high. Often these diagnoses are not included in clinical progress reports or in the discharge report, reflecting poor condition awareness on the part of our colleagues. Implementation of a clinical protocol and its diffusion throughout the hospital may be important tools to achieving more efficient and consistent management of these conditions.
Subject(s)
Incidental Findings , Inpatients , Kidney Diseases/diagnosis , Adult , Aged , Aged, 80 and over , Algorithms , Chronic Disease , Creatinine/blood , Cross-Sectional Studies , Disease Progression , Female , Glomerular Filtration Rate , Hospital Records , Hospitals, Urban/statistics & numerical data , Humans , Kidney Diseases/blood , Kidney Diseases/epidemiology , Male , Middle Aged , Quality Improvement , Retrospective Studies , Sampling Studies , Spain/epidemiology , Young AdultABSTRACT
INTRODUCTION: The frequency and clinical impact of chronic kidney disease (CKD) in type 2 diabetes patients (DM2) and the benefits of early intervention highlights the need for close collaboration in detection and management between Nephrology and Primary Health Care. OBJECTIVE: Our objectives were to estimate the prevalence of CKD in DM2 patients controlled by primary care and evaluate the need to early referral of CKD DM2 patients to renal specialists. STUDY POPULATION: patients older than 18 years of age, with analysis made for any reason in the 16 Health Centers of Health Sector Alcañiz (84,340 inhabitants)during 2008. VARIABLES: age, sex, serum creatinine,urine albumin/creatinine ratio, glycated hemoglobin,potassium and hemoglobin. We calculated the estimated glomerular filtration rate (eGF) by the MDRD formula. Were viewed the Consensus Document S.E.N.-SEMFyC ERC 2008 criteria for referral to renal specialists. RESULTS: Of the 16,814 patients enrolled, 3,466 (20.6%) had DM2. In DM2 patients, the prevalence of CKD was 34.6% (IC 95%, 33-36.2). eGF <60 ml/min/m2 was recorded in 25.2% of DM2 patients. In this subgroup the prevalence of albuminuria was 31.7%. Met criteria for referral to renal specialists 104 (3%) DM2 patients and 132 (1%) non diabetic patients(p <0.0001). CONCLUSIONS: The prevalence of DM2 in the Health Centers is high, with frequent presence of CKD and albuminuria. An important percentage of patients meets the referral S.E.N.-SEMFyC criteria. The collaboration with primary care is essential in early detection and monitoring of these patients, and common primary care and nephrology protocols are need.Key words: Chronic kidney disease. Diabetes
Subject(s)
Diabetes Mellitus, Type 2/epidemiology , Diabetic Nephropathies/epidemiology , Kidney Diseases/epidemiology , Primary Health Care/statistics & numerical data , Adult , Aged , Aged, 80 and over , Albuminuria/epidemiology , Chronic Disease , Cross-Sectional Studies , Early Diagnosis , Glomerular Filtration Rate , Humans , Kidney Diseases/diagnosis , Middle Aged , Prevalence , Spain/epidemiology , Young AdultABSTRACT
Data were collected in 18.922 patients attending Primary Care Centers in Alcañiz (Spain), mean age 59,96 +/- 17 years, 42,9 % males and 57,1 % females. The prevalence of eGFR was: stage 3 (30-59 ml/min/1,73 m2) 15,7 %; stage 4 (15-29 ml/min/1,73 m2) 0,6 %; stage 5 no dialysis (GFR < 15 ml/min/1.73 m2) 0,1 %. This prevalence increased with age and 32 % of patients attending Primary Care services over 65 years presented a eGFR < 60 ml/min/1,73 m2. Of the total patients with eGFR < 60 ml/min/1,73 m2, 26 % had normal serum creatinine levels. Protocol implementation could implied for the Renal Unit an increase in the number of patients, specially the oldest ones. This study documents the substantial prevalence of significantly abnormal renal function among patients at Primary Care level and the importance of Primary Care collaboration in their early identification and appropriate management.
Subject(s)
Glomerular Filtration Rate , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/epidemiology , Cross-Sectional Studies , Female , Humans , Kidney Failure, Chronic/physiopathology , Male , Middle Aged , Nephrology , Prevalence , Referral and ConsultationABSTRACT
La incidencia de Enfermedad Renal Crónica (ERC) en los18.922 pacientes con determinación bioquímica realizada en los Centros de Salud del Sector Sanitario de Alcañiz a lo largo de 2006 fue del 16,4% (mujeres 19,1%, varones12,9%, p < 0,0001). Por estadios K/DOQI la mayoría de los casos pertenecen al estadio 3. Encontramos Insuficiencia renal oculta en 810 pacientes (4,3%), todos ellos mujeres. Esta elevada prevalencia de ERC y de ERC oculta puede detectarse de forma precoz mediante la inclusión en los resultados de laboratorio del cálculo del filtrado glomerular por la fórmula MDRD y hace necesaria la implantación de un protocolo que facilite una colaboración estrecha con Atención Primaria. El control y seguimiento de pacientes con ERC estable y sin complicaciones recaería principalmente sobre el Médico de Cabecera, siendo necesario mantener su formación y el apoyo por parte de nefrología (AU)
Data were collected in 18.922 patients attending Primary Care Centers in Alcañiz (Spain), mean age 59,96 ± 17 years, 42,9%males and 57,1% females. The prevalence of eGFR was: stage 3(30-59 ml/min/1,73 m2) 15,7%; stage 4 (15-29 ml/min/1,73 m2)0,6%; stage 5 no dialysis (GFR < 15 ml/min/1.73 m2) 0,1%. This prevalence increased with age and 32% of patients attending Primary Care services over 65 years presented a e GFR < 60ml/min/1,73 m2. Of the total patients with eGFR < 60ml/min/1,73 m2, 26% had normal serum creatinine levels. Protocol implementation could implied for the Renal Unit an increase in the number of patients, specially the oldest ones. This study documents the substantial prevalence of significantly abnormal renal function among patients at Primary Care level and the importance of Primary Care collaboration in their early identification and appropriate management (AU)
Subject(s)
Humans , Glomerular Filtration Rate , Renal Insufficiency/epidemiology , Primary Health Care/statistics & numerical data , Referral and Consultation/statistics & numerical data , Risk Factors , Cardiovascular Diseases/prevention & controlABSTRACT
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