Agrawal Varun, Ghosh Amit K, Barnes Michael A, McCullough Peter A
Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA.
Am J Kidney Dis. 2008 Dec;52(6):1061-9. doi: 10.1053/j.ajkd.2008.06.022. Epub 2008 Oct 30.
The National Kidney Foundation published Kidney Disease Outcomes Quality Initiative guidelines that recommend early detection and management of chronic kidney disease (CKD) and timely referral to a nephrologist. Many patients with CKD are seen by primary care physicians who are less experienced than nephrologists to offer optimal pre-end-stage renal disease care. It is not known whether current postgraduate training adequately prepares a future internist in CKD management.
Cross-sectional study using an online questionnaire survey.
SETTING & PARTICIPANTS: Internal medicine residents in the United States (n = 479) with postgraduate year (PGY) distribution of 166 PGY1, 187 PGY2, and 126 PGY3.
Awareness and knowledge of CKD clinical practice guidelines measured by using the questionnaire instrument.
OUTCOMES & MEASUREMENTS: Total performance score (maximum = 30).
Half the residents did not know that the presence of kidney damage (proteinuria) for 3 or more months defines CKD. One-third of the residents did not know the staging of CKD. All residents (99%) knew the traditional risk factors for CKD of diabetes and hypertension, but were less aware of other risk factors of obesity (38%), elderly age (71%), and African American race (68%). Most residents (87%) were aware of estimated glomerular filtration rate in the evaluation of patients with CKD. Most residents (90%) knew goal blood pressure (<130/80 mm Hg) for patients with CKD. Most residents identified anemia (91%) and bone disorder (82%) as complications of CKD, but only half recognized CKD as a risk factor for cardiovascular disease. Most residents (90%) chose to refer a patient with a glomerular filtration rate less than 30 mL/min/1.73 m(2) to a nephrologist. A small improvement in mean performance score was observed with increasing PGY (PGY1, 68.8% +/- 15.4%; PGY2, 72.9% +/- 14.7%; and PGY3, 74.0% +/- 12.0%; P = 0.004).
Self-selection, lack of nonrespondent data.
Our survey identified specific gaps in knowledge of CKD guidelines in internal medicine residents. Educational efforts in increasing awareness of these guidelines may improve CKD management and clinical outcomes.
美国国家肾脏基金会发布了《肾脏病预后质量倡议》指南，建议对慢性肾脏病（CKD）进行早期检测和管理，并及时转诊至肾病科医生处。许多CKD患者由初级保健医生诊治，这些医生在提供最佳的终末期肾病前期护理方面不如肾病科医生经验丰富。目前尚不清楚当前的研究生培训是否能让未来的内科医生充分做好CKD管理的准备。
采用在线问卷调查的横断面研究。
美国的内科住院医师（n = 479），研究生年级（PGY）分布为166名PGY1、187名PGY2和126名PGY3。
使用问卷工具测量的对CKD临床实践指南的知晓度和知识水平。
总表现得分（满分 = 30分）。
一半的住院医师不知道肾脏损伤（蛋白尿）持续3个月或更长时间可定义为CKD。三分之一的住院医师不知道CKD的分期。所有住院医师（99%）都知道糖尿病和高血压是CKD的传统危险因素，但对肥胖（38%）、老年（71%）和非裔美国人种族（68%）等其他危险因素的知晓度较低。大多数住院医师（87%）知道在评估CKD患者时估算肾小球滤过率。大多数住院医师（90%）知道CKD患者的目标血压（<130/80 mmHg）。大多数住院医师将贫血（91%）和骨病（82%）识别为CKD的并发症，但只有一半的人认识到CKD是心血管疾病的危险因素。大多数住院医师（90%）选择将肾小球滤过率低于30 mL/min/1.73 m²的患者转诊至肾病科医生处。随着PGY增加，平均表现得分有小幅提高（PGY1，68.8% ± 15.4%；PGY2，72.9% ± 14.7%；PGY3，74.0% ± 12.0%；P = 0.004）。
自我选择，缺乏无应答者数据。
我们的调查发现内科住院医师在CKD指南知识方面存在特定差距。加强对这些指南的认识的教育努力可能会改善CKD管理和临床结局。
