Ferris Maria, Shoham David A, Pierre-Louis Margareth, Mandhelker Lawrence, Detwiler Randal K, Kshirsagar Abhijit V
Division of Nephrology and Hypertension, School of Medicine, Office of Continuous Quality Improvement, University of North Carolina, Chapel Hill, North Carolina 27599-7155, USA.
Am J Med Sci. 2009 Feb;337(2):93-7. doi: 10.1097/MAJ.0b013e318181288e.
Although awareness of chronic kidney disease (CKD) is low in outpatient settings, the prevalence of unrecognized CKD in the inpatient setting is unknown.
We examined the extent of unlabeled CKD among adults admitted to a tertiary-care hospital in North Carolina, based upon a combination of web-based medical record review, chart review, ICD-9 codes and laboratory information from 2000 to 2005.
A total of 9772 patients had 2 or more serum creatinine measures at least 6 months apart and demographic variables for race and sex; 431 met criteria for stage 5 CKD (estimated glomerular filtration rate<15 mL/min/1.73 m2) and 6851 patients had stage 2 to 4 CKD (estimated glomerular filtration rate between 15 and 89 mL/min/1.73 m2). Within the latter groups, 3002 had stage 3 to 4 CKD, and 3849 had stage 2 CKD. Forty-three percent were male, 37% had a minority race/ethnicity. The number of patients not labeled as having CKD by ICD-9 code was 2176 (72.5%). Women and whites were less likely than men and minorities to be labeled as having CKD by ICD-9 codes. Medical record review of 600 randomly selected patients identified 399 patients with stage 3 or 4 CKD diagnosis. ICD-9 codes had a sensitivity of 0.50, specificity of 0.88, and positive predictive value of 0.39.
A large proportion of individuals with CKD are going unrecognized in the hospital setting. Automatic laboratory reporting of GFR and education about CKD may help increase awareness in both the inpatient settings.
尽管门诊环境中对慢性肾脏病（CKD）的认知度较低，但住院环境中未被识别的CKD患病率尚不清楚。
我们基于2000年至2005年的网络病历审查、病历审查、ICD - 9编码和实验室信息，对北卡罗来纳州一家三级医疗医院收治的成年患者中未标记的CKD程度进行了检查。
共有9772名患者间隔至少6个月进行了2次或更多次血清肌酐测量，并获取了种族和性别的人口统计学变量；431名符合5期CKD标准（估计肾小球滤过率<15 mL/min/1.73 m²），6851名患者患有2至4期CKD（估计肾小球滤过率在15至89 mL/min/1.73 m²之间）。在后一组中，3002名患有3至4期CKD，3849名患有2期CKD。43%为男性，37%属于少数族裔。未被ICD - 9编码标记为患有CKD的患者数量为2176名（72.5%）。女性和白人被ICD - 9编码标记为患有CKD的可能性低于男性和少数族裔。对600名随机选择的患者进行病历审查，确定了399名患有3或4期CKD诊断的患者。ICD - 9编码的敏感性为0.50，特异性为0.88，阳性预测值为0.39。
在医院环境中，很大一部分CKD患者未被识别。自动报告肾小球滤过率（GFR）以及开展关于CKD的教育可能有助于提高住院环境中的认知度。
