Christiana Care Health System, Center for Outcomes Research, Newark, DE 19713, USA.
Am J Kidney Dis. 2012 Mar;59(3 Suppl 2):S24-33. doi: 10.1053/j.ajkd.2011.11.019.
Chronic kidney disease (CKD) is a well-known risk factor for cardiovascular mortality, but little is known about the association between physician utilization and cardiovascular disease risk-factor control in patients with CKD. We used 2005-2010 data from the National Kidney Foundation's Kidney Early Evaluation Program (KEEP) to examine this association at first and subsequent screenings.
Control of risk factors was defined as control of blood pressure, glycemia, and cholesterol levels. We used multinomial logistic regression to examine the association between participant characteristics and seeing a nephrologist after adjusting for kidney function and paired t tests or McNemar tests to compare characteristics at first and second screenings.
Of 90,009 participants, 61.3% had a primary care physician only, 2.9% had seen a nephrologist, and 15.3% had seen another specialist. The presence of 3 risk factors (hypertension, diabetes, and hypercholesterolemia) increased from 26.8% in participants with CKD stages 1-2 to 31.9% in those with stages 4-5. Target levels of all risk factors were achieved in 7.2% of participants without a physician, 8.3% of those with a primary care physician only, 9.9% of those with a nephrologist, and 10.3% of those with another specialist. Of up to 7,025 participants who met at least one criterion for nephrology consultation at first screening, only 12.3% reported seeing a nephrologist. Insurance coverage was associated strongly with seeing a nephrologist. Of participants who met criteria for nephrology consultation, 406 (5.8%) returned for a second screening, of whom 19.7% saw a nephrologist. The percentage of participants with all risk factors controlled was higher at the second screening (20.9% vs 13.3%).
Control of cardiovascular risk factors is poor in the KEEP population. The percentage of participants seeing a nephrologist is low, although better after the first screening. Identifying communication barriers between nephrologists and primary care physicians may be a new focus for KEEP.
慢性肾脏病（CKD）是心血管死亡率的一个众所周知的危险因素，但关于 CKD 患者的医生利用与心血管疾病危险因素控制之间的关系知之甚少。我们使用 2005-2010 年国家肾脏基金会肾脏早期评估计划（KEEP）的数据，在首次和后续筛查中检查这种关联。
危险因素的控制定义为控制血压、血糖和胆固醇水平。我们使用多项逻辑回归检查参与者特征与调整肾功能后看肾病专家之间的关联，并使用配对 t 检验或 McNemar 检验比较首次和第二次筛查时的特征。
在 90,009 名参与者中，61.3%只有初级保健医生，2.9%看过肾病专家，15.3%看过其他专科医生。患有 3 种危险因素（高血压、糖尿病和高胆固醇血症）的患者比例从 CKD 1-2 期的 26.8%增加到 4-5 期的 31.9%。在没有医生的患者中，7.2%达到了所有危险因素的目标水平，在只有初级保健医生的患者中为 8.3%，在有肾病专家的患者中为 9.9%，在有其他专科医生的患者中为 10.3%。在首次筛查中至少符合肾病会诊标准的多达 7025 名患者中，只有 12.3%报告看过肾病专家。保险覆盖与看肾病专家有很强的关联。在符合肾病会诊标准的患者中，有 406 名（5.8%）进行了第二次筛查，其中 19.7%看过肾病专家。第二次筛查时，所有危险因素得到控制的患者比例更高（20.9% vs. 13.3%）。
KEEP 人群中心血管危险因素的控制较差。尽管在首次筛查后有所改善，但看肾病专家的患者比例仍然较低。确定肾病专家和初级保健医生之间的沟通障碍可能是 KEEP 的一个新重点。
