- •The care for people with early stage chronic kidney disease (CKD) is mostly done in primary care.
- •In this primary care survey, only about a third of respondents were fully confident in the screening and diagnosis of CKD.
- •Only up to about a quarter were fully confident in CKD presentation, staging and prognosis.
- •Only a third of respondents were fully confident regarding appropriate management strategies.
- •Knowledge of the staging and diagnosis of CKD predicts ability to initiate right management.
- Stevens P.E.
- Levin A.
- Stevens P.E.
- Levin A.
2.1 Setting and data sources
2.2 Outcomes of survey
2.3 Statistical analysis
3.1 Characteristics of survey respondents and their practice
|Median (interquartile range) age (years)||51 (36–61)|
|General practitioner||220 (82.7)|
|Assistant Doctor||5 (1.9)|
|Other specialist||4 (1.5)|
|Family medicine||3 (1.13)|
|United Kingdom||41 (15.4)|
|Other countries||26 (9.8)|
|The Netherlands||6 (2.3)|
3.2 Screening and diagnosis of CKD in primary care
3.3 CKD clinical presentation, staging and prognosis
3.4 CKD risks and complications in diabetes
3.4.1 Treatment strategies and the role of RAAS-Is, SGLT2-Is and other newer agents in DKD
3.5 Factors influencing the confidence to identify and initiate treatment strategies
|Characteristics||OR (95% CI)||p-value|
|Confidence in the ability to select appropriate management for preventing or slowing CKD|
|Age (years) (per unit increase)||1.02 (0.99–1.05)||0.14|
|Male vs females||1.14 (0.57–2.31)||0.71|
|GPs vs nurses/others||0.79 (0.25–2.52)||0.70|
|Diabetologists vs nurses/others||1.33 (0.15–12.01)||0.80|
|Confidence in criteria for diagnosis of CKD and DKD vs no confidence||6.50 (3.08–13.72)||< 0.001|
|Confidence in knowledge of stages of kidney disease vs no confidence||9.92 (3.63–27.13)||< 0.001|
|Confidence in the understanding of the use of ACE-Is or ARBs and their renal benefits|
|Age (years) (per unit increase)||1.02 (0.99–1.05)||0.15|
|Male vs females||1.44 (0.73–2.87)||0.30|
|GPs vs nurses/others||2.19 (0.86–5.60)||0.10|
|Diabetologists vs nurses/others||1.22 (0.17–8.59)||0.84|
|Confidence in criteria for diagnosis of CKD and DKD vs no confidence||3.64 (1.71–7.76)||0.001|
|Confidence in knowledge of stages of kidney disease vs no confidence||4.22 (2.00–8.90)||< 0.001|
|Confidence in initiating newer agents such as SGLT2-Is and GLP1RAs for DKD|
|Age (years) (per unit increase)||1.02 (1.00–1.05)||0.065|
|Male vs females||1.05 (0.53–2.08)||0.90|
|GPs vs nurses/others||0.46 (0.16–1.33)||0.15|
|Diabetologists vs nurses/others||0.56 (0.07–4.48)||0.58|
|Confidence in criteria for diagnosis of CKD and DKD vs no confidence||8.21 (3.96–17.02)||< 0.001|
|Confidence in knowledge of stages of kidney disease vs no confidence||4.40 (1.90–10.20)||0.001|
4.1 Key findings
4.2 Comparisons with previous studies
4.3 Potential explanation of findings
4.4 Implications of findings
4.5 Strengths and limitations
Conflict of interest
Appendix A. Supplementary material
- Supplementary Figure 1
International Diabetes Federation. IDF Diabetes Atlas, 10th edn. 2021. http://www.diabetesatlas.org/. Accessed on 28 March 2022.
- Type 2 diabetes.Lancet. 2017; 389: 2239-2251
- The economic costs of type 2 diabetes: a global systematic review.Pharmacoeconomics. 2015; 33: 811-831
- US renal data system 2014 annual data report: epidemiology of kidney disease in the United States.Am. J. Kidney Dis. 2015; 66 (Svii, S1-305)
- Understanding CKD among patients with T2DM: prevalence, temporal trends, and treatment patterns-NHANES 2007-2012.BMJ Open Diabetes Res. Care. 2016; 4e000154
- Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group M. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline.Ann. Intern Med. 2013; 158: 825-830
- Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease.Kidney Int. Suppl. 2013; 3: 1-150
Diabetes UK Position statement: preventing kidney failure in people with diabetes. August 2016. [Accessed October 2022]. www.diabetes.org.uk/Professionals/Position-statements-reports/Specialist- care-for-children-and-adults-and-complications/Preventing-kidney-failure-in-people-with-diabetes.
Diabetes UK. Diabetic nephropathy – kidney disease. [Accessed October 2022]. www.diabetes.co.uk/diabetes-complications/kidney-disease.html.
- UK renal registry 19th annual report: chapter 1 UK RRT adult incidence in 2015: national and centre-specific analyses.Nephron. 2017; 137: 11-44
- The contribution of chronic kidney disease to the global burden of major noncommunicable diseases.Kidney Int. 2011; 80: 1258-1270
- Kidney disease and increased mortality risk in type 2 diabetes.J. Am. Soc. Nephrol. 2013; 24: 302-308
- Prediction of prevalence of chronic kidney disease in diabetic patients in countries of the European Union up to 2025.Nephrol. Dial. Transpl. 2015; 30: iv113-iv118
- Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.New Engl. J. Med. 2003; 348: 383-393
- Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).Diabetologia. 2018; 61: 2461-2498
- Integrated primary care: is this the solution to the diabetes epidemic?.Diabet. Med. 2017; 34: 748-750
- The cost-effectiveness of improving diabetes care in U.S. federally qualified community health centers.Health Serv. Res. 2007; 42 (discussion 2294-2323): 2174-2193
- Personalised treatment targets in type 2 diabetes patients: the Dutch approach.Prim. Care Diabetes. 2017; 11: 71-77
- Standards of medical care in diabetes-2022 abridged for primary care providers.Clin. Diabetes. 2022; 40: 10-38
- Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes.New Engl. J. Med. 2001; 345: 851-860
- Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy.New Engl. J. Med. 2001; 345: 861-869
- Challenges perceived by primary care providers to educating patients about chronic kidney disease.J. Ren. Care. 2012; 38: 174-181
- Albuminuria testing in hypertension and diabetes: an individual-participant data meta-analysis in a global consortium.Hypertension. 2021; 78: 1042-1052
- Albuminuria testing by race and ethnicity among patients with hypertension with and without diabetes.Am. J. Nephrol. 2019; 50: 48-54
- The role of primary care in the management of the chronic kidney disease population.Adv. Chronic Kidney Dis. 2010; 17: 246-253
- Primary care management of chronic kidney disease.J. Gen. Intern Med. 2011; 26: 386-392
- Intensification of diabetes therapy and time until A1C goal attainment among patients with newly diagnosed type 2 diabetes who fail metformin monotherapy within a large integrated health system.Diabetes Care. 2016; 39: 1527-1534
- Impact of COVID-19 on routine care for chronic diseases: a global survey of views from healthcare professionals.Diabetes Metab. Syndr. 2020; 14: 965-967
- Primary care physicians' perceptions of barriers and facilitators to management of chronic kidney disease: a mixed methods study.PLoS One. 2019; 14e0221325
- CKD risk factors reported by primary care physicians: do guidelines make a difference?.Am. J. Kidney Dis. 2006; 47: 72-77
- Provision of care for chronic kidney disease by non-nephrologists in a developing nation: a national survey.BMJ Open. 2016; 6e010832
- Barnes M. awareness and knowledge of clinical practice guidelines for CKD among internal medicine residents: a national online survey.Am. J. Kidney Dis. Off. J. Natl. Kidney Found. 2008; 52: 1061-1069
- Chronic kidney disease care delivered by US family medicine and internal medicine trainees: results from an online survey.BMC Med. 2006; 4: 30
- A systematic review of interventions targeting primary care or community based professionals on cardio-metabolic risk factor control in people with diabetes.Diabetes Res. Clin. Pr. 2016; 113: 1-13
- The GIANT study, a cluster-randomised controlled trial of efficacy of education of doctors about type 2 diabetes mellitus management guidelines in primary care practice.Diabetes Res. Clin. Pr. 2012; 98: 38-45
Clinical Inertia. Annals of Internal Medicine. 2001;135(9):825–834.
- The impact of the COVID pandemic on primary care diabetes services in the UK: a cross-sectional national survey of views of health professionals delivering diabetes care.Prim. Care Diabetes. 2022; 16: 257-263
- Screening for kidney disease in adults with diabetes.Diabetes Care. 2005; 28: 1813-1816
- Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis.Lancet. 2010; 375: 2073-2081
- Evaluating the impact of an enhanced primary care diabetes service on diabetes outcomes: a before-after study.Prim. Care Diabetes. 2017; 11: 171-177
- Quality of care of people with type 2 diabetes in eight European countries: findings from the Guideline Adherence to Enhance Care (GUIDANCE) study.Diabetes Care. 2013; 36: 2628-2638
- Improving primary care for patients with chronic illness: the chronic care model, Part 2.JAMA. 2002; 288: 1909-1914
- Evaluation of the clinical and cost effectiveness of intermediate care clinics for diabetes (ICCD): a multicentre cluster randomised controlled trial.PLoS One. 2014; 9e93964
- Social deprivation and prevalence of chronic kidney disease in the UK: workload implications for primary care.QJM. 2012; 105: 167-175
- Global prevalence of chronic kidney disease - a systematic review and meta-analysis.PLoS One. 2016; 11e0158765
Healthcare Quality and Improvement Partnership. National chronic kidney disease audit. 2017. Available from: https://www.lshtm.ac.uk/media/9951. Accessed on 15 November 2022.
- All patients with diabetes should have annual UACR tests. Why is that so hard?.BMJ Qual. Improv Rep. 2016; 5: 1
- Improving proteinuria screening with mailed smartphone urinalysis testing in previously unscreened patients with hypertension: a randomized controlled trial.BMC Nephrol. 2019; 20: 132
- Effect of 2 clinical decision support strategies on chronic kidney disease outcomes in primary care: a cluster randomized trial.JAMA Netw. Open. 2018; 1e183377
- The limitations of online surveys.Indian J. Psychol. Med. 2020; 42: 575-576
Publication stageIn Press Corrected Proof
User licenseCreative Commons Attribution (CC BY 4.0) |
- Read, print & download
- Redistribute or republish the final article
- Text & data mine
- Translate the article
- Reuse portions or extracts from the article in other works
- Sell or re-use for commercial purposes
Elsevier's open access license policy