Akbari Ayub, Swedko Peter J, Clark Heather D, Hogg William, Lemelin Jacques, Magner Peter, Moore Lisa, Ooi Daylily
Department of Medicine, University of Ottawa, Ontario, Canada.
Arch Intern Med. 2004 Sep 13;164(16):1788-92. doi: 10.1001/archinte.164.16.1788.
Serum creatinine concentration is an inadequate screening test for chronic kidney disease, especially in elderly patients. We hypothesized that laboratory reporting of estimated glomerular filtration rate (GFR) accompanied with an educational intervention would improve recognition of chronic kidney disease (CKD).
We conducted a before-and-after study at an outpatient family medicine practice. Patients 65 years or older for whom a Cockcroft-Gault GFR could be calculated from their medical record were included. The intervention consisted of automatic reporting of estimated GFR by the hospital laboratory along with an educational intervention directed toward the primary care physicians. The primary outcome was the recognition of CKD (defined as a Cockroft-Gault GFR <60 mL/min [<1.0 mL/s]) by the primary care physician. Factors associated with the recognition of CKD were also determined.
The study population comprised 324 patients. Prior to the study intervention, 22.4% of patients with CKD were recognized, which increased to 85.1% after the intervention. Before the intervention, recognition was more likely in male subjects (odds ratio, 4.3; 95% confidence interval, 1.9-9.8) and patients with diabetes (odds ratio, 3.4; 95% confidence interval, 1.6-7.6). These associations were no longer statistically significant after the intervention.
Laboratory reporting of estimated GFR coupled with an educational program markedly improves the recognition of CKD in the primary care setting.
血清肌酐浓度对于慢性肾脏病而言并非充分的筛查检测手段，在老年患者中尤其如此。我们推测，估算肾小球滤过率（GFR）的实验室报告并辅以教育干预可提高对慢性肾脏病（CKD）的识别率。
我们在一家门诊家庭医学诊所开展了一项前后对照研究。纳入了年龄在65岁及以上且可根据其病历计算Cockcroft-Gault GFR的患者。干预措施包括医院实验室自动报告估算的GFR以及针对初级保健医生的教育干预。主要结局是初级保健医生对CKD的识别（定义为Cockroft-Gault GFR<60 mL/分钟[<1.0 mL/秒]）。还确定了与CKD识别相关的因素。
研究人群包括324例患者。在研究干预之前，22.4%的CKD患者被识别出来，干预后这一比例增至85.1%。干预前，男性受试者（优势比，4.3；95%置信区间，1.9 - 9.8）和糖尿病患者（优势比，3.4；95%置信区间，1.6 - 7.6）更有可能被识别。干预后这些关联不再具有统计学意义。
估算GFR的实验室报告与教育计划相结合可显著提高初级保健环境中对CKD的识别率。
