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Published in: BMC Nephrology 1/2013

Open Access 01-12-2013 | Research article

Perceptions and use of the national kidney foundation KDOQI guidelines: a survey of U.S. renal healthcare providers

Authors: Michelle M Estrella, Bernard G Jaar, Kerri L Cavanaugh, Chester H Fox, Mark A Perazella, Sandeep S Soman, Emily Howell, Michael V Rocco, Michael J Choi

Published in: BMC Nephrology | Issue 1/2013

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Abstract

Background

The National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) developed guidelines to care for patients with chronic kidney disease (CKD). While these are disseminated through the NKF’s website and publications, the guidelines’ usage remains suboptimal. The KDOQI Educational Committee was formed to identify barriers to guideline implementation, determine provider and patient educational needs and develop tools to improve care of patients with CKD.

Methods

An online survey was conducted from May to September 2010 to evaluate renal providers’ familiarity, current use of and attitudes toward the guidelines and tools to implement the guidelines.

Results

Most responders reported using the guidelines often and felt that they could be easily implemented into clinical practice; however, approximately one-half identified at least one barrier. Physicians and physician extenders most commonly cited the lack of evidence supporting KDOQI guidelines while allied health professionals most commonly listed patient non-adherence, unrealistic guideline goals and provider time-constraints. Providers thought that the guidelines included too much detail and identified the lack of a quick resource as a barrier to clinical implementation. Most were unaware of the Clinical Action Plans.

Conclusions

Perceived barriers differed between renal clinicians and allied health professionals; educational and implementation tools tailored for different providers are needed.
Appendix
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Literature
1.
go back to reference Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, Van Lente F, Levey AS: Prevalence of chronic kidney disease in the United States. JAMA. 2007, 298 (17): 2038-2047.CrossRefPubMed Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, Van Lente F, Levey AS: Prevalence of chronic kidney disease in the United States. JAMA. 2007, 298 (17): 2038-2047.CrossRefPubMed
2.
go back to reference U.S. Renal Data System, USRDS 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. 2010, Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, In U.S. Renal Data System, USRDS 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. 2010, Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, In
3.
go back to reference Go AS, Yang J, Ackerson LM, Lepper K, Robbins S, Massie BM, Shlipak MG: Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure: the Anemia in Chronic Heart Failure: Outcomes and Resource Utilization (ANCHOR) Study. Circulation. 2006, 113 (23): 2713-2723.CrossRefPubMed Go AS, Yang J, Ackerson LM, Lepper K, Robbins S, Massie BM, Shlipak MG: Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure: the Anemia in Chronic Heart Failure: Outcomes and Resource Utilization (ANCHOR) Study. Circulation. 2006, 113 (23): 2713-2723.CrossRefPubMed
4.
go back to reference James MT, Quan H, Tonelli M, Manns BJ, Faris P, Laupland KB, Hemmelgarn BR: CKD and risk of hospitalization and death with pneumonia. Am J Kidney Dis. 2009, 54 (1): 24-32.CrossRefPubMed James MT, Quan H, Tonelli M, Manns BJ, Faris P, Laupland KB, Hemmelgarn BR: CKD and risk of hospitalization and death with pneumonia. Am J Kidney Dis. 2009, 54 (1): 24-32.CrossRefPubMed
5.
go back to reference Nitsch D, Nonyane BA, Smeeth L, Bulpitt CJ, Roderick PJ, Fletcher A: CKD and hospitalization in the elderly: a community-based cohort study in the United Kingdom. Am J Kidney Dis. 2011, 57 (5): 664-672.CrossRefPubMedPubMedCentral Nitsch D, Nonyane BA, Smeeth L, Bulpitt CJ, Roderick PJ, Fletcher A: CKD and hospitalization in the elderly: a community-based cohort study in the United Kingdom. Am J Kidney Dis. 2011, 57 (5): 664-672.CrossRefPubMedPubMedCentral
6.
go back to reference Grams ME, Astor BC, Bash LD, Matsushita K, Wang Y, Coresh J: Albuminuria and estimated glomerular filtration rate independently associate with acute kidney injury. J Am Soc Nephrol. 2010, 21 (10): 1757-1764.CrossRefPubMedPubMedCentral Grams ME, Astor BC, Bash LD, Matsushita K, Wang Y, Coresh J: Albuminuria and estimated glomerular filtration rate independently associate with acute kidney injury. J Am Soc Nephrol. 2010, 21 (10): 1757-1764.CrossRefPubMedPubMedCentral
7.
go back to reference Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, Coresh J, Gansevoort RT: 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 (9731): 2073-2081.CrossRefPubMedPubMedCentral Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, Coresh J, Gansevoort RT: 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 (9731): 2073-2081.CrossRefPubMedPubMedCentral
8.
go back to reference Jones C, Roderick P, Harris S, Rogerson M: Decline in kidney function before and after nephrology referral and the effect on survival in moderate to advanced chronic kidney disease. Nephrol Dial Transplant. 2006, 21 (8): 2133-2143.CrossRefPubMed Jones C, Roderick P, Harris S, Rogerson M: Decline in kidney function before and after nephrology referral and the effect on survival in moderate to advanced chronic kidney disease. Nephrol Dial Transplant. 2006, 21 (8): 2133-2143.CrossRefPubMed
9.
go back to reference Stack AG: Impact of timing of nephrology referral and pre-ESRD care on mortality risk among new ESRD patients in the United States. Am J Kidney Dis. 2003, 41 (2): 310-318.CrossRefPubMed Stack AG: Impact of timing of nephrology referral and pre-ESRD care on mortality risk among new ESRD patients in the United States. Am J Kidney Dis. 2003, 41 (2): 310-318.CrossRefPubMed
10.
go back to reference Thilly N, Boini S, Loos-Ayav C, Kessler M, Briancon S, Frimat L: Impact of predialysis therapeutic practices on patient outcomes during the first year of dialysis: the Pharmacoepidemiologic AVENIR study. Med Care. 2012, 50 (1): 35-42.CrossRefPubMed Thilly N, Boini S, Loos-Ayav C, Kessler M, Briancon S, Frimat L: Impact of predialysis therapeutic practices on patient outcomes during the first year of dialysis: the Pharmacoepidemiologic AVENIR study. Med Care. 2012, 50 (1): 35-42.CrossRefPubMed
11.
go back to reference McClellan WM, Wasse H, McClellan AC, Kipp A, Waller LA, Rocco MV: Treatment center and geographic variability in pre-ESRD care associate with increased mortality. J Am Soc Nephrol. 2009, 20 (5): 1078-1085.CrossRefPubMedPubMedCentral McClellan WM, Wasse H, McClellan AC, Kipp A, Waller LA, Rocco MV: Treatment center and geographic variability in pre-ESRD care associate with increased mortality. J Am Soc Nephrol. 2009, 20 (5): 1078-1085.CrossRefPubMedPubMedCentral
12.
go back to reference Charles RF, Powe NR, Jaar BG, Troll MU, Parekh RS, Boulware LE: Clinical testing patterns and cost implications of variation in the evaluation of CKD among US physicians. Am J Kidney Dis. 2009, 54 (2): 227-237.CrossRefPubMedPubMedCentral Charles RF, Powe NR, Jaar BG, Troll MU, Parekh RS, Boulware LE: Clinical testing patterns and cost implications of variation in the evaluation of CKD among US physicians. Am J Kidney Dis. 2009, 54 (2): 227-237.CrossRefPubMedPubMedCentral
14.
go back to reference Rutkowski M, Mann W, Derose S, Selevan D, Pascual N, Diesto J, Crooks P: Implementing KDOQI CKD definition and staging guidelines in Southern California Kaiser Permanente. Am J Kidney Dis. 2009, 53 (3 Suppl 3): S86-S99.CrossRefPubMed Rutkowski M, Mann W, Derose S, Selevan D, Pascual N, Diesto J, Crooks P: Implementing KDOQI CKD definition and staging guidelines in Southern California Kaiser Permanente. Am J Kidney Dis. 2009, 53 (3 Suppl 3): S86-S99.CrossRefPubMed
15.
go back to reference Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR: Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999, 282 (15): 1458-1465.CrossRefPubMed Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR: Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999, 282 (15): 1458-1465.CrossRefPubMed
16.
go back to reference Leape LL, Weissman JS, Schneider EC, Piana RN, Gatsonis C, Epstein AM: Adherence to practice guidelines: the role of specialty society guidelines. Am Heart J. 2003, 145 (1): 19-26.CrossRefPubMed Leape LL, Weissman JS, Schneider EC, Piana RN, Gatsonis C, Epstein AM: Adherence to practice guidelines: the role of specialty society guidelines. Am Heart J. 2003, 145 (1): 19-26.CrossRefPubMed
17.
go back to reference Maue SK, Segal R, Kimberlin CL, Lipowski EE: Predicting physician guideline compliance: an assessment of motivators and perceived barriers. Am J Manag Care. 2004, 10 (6): 383-391.PubMed Maue SK, Segal R, Kimberlin CL, Lipowski EE: Predicting physician guideline compliance: an assessment of motivators and perceived barriers. Am J Manag Care. 2004, 10 (6): 383-391.PubMed
18.
go back to reference Strippoli GF, Craig JC, Schena FP: The number, quality, and coverage of randomized controlled trials in nephrology. J Am Soc Nephrol. 2004, 15 (2): 411-419.CrossRefPubMed Strippoli GF, Craig JC, Schena FP: The number, quality, and coverage of randomized controlled trials in nephrology. J Am Soc Nephrol. 2004, 15 (2): 411-419.CrossRefPubMed
19.
go back to reference Drueke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, Burger HU, Scherhag A: Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med. 2006, 355 (20): 2071-2084.CrossRefPubMed Drueke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, Burger HU, Scherhag A: Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med. 2006, 355 (20): 2071-2084.CrossRefPubMed
20.
go back to reference Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, Wolfson M, Reddan D: Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006, 355 (20): 2085-2098.CrossRefPubMed Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, Wolfson M, Reddan D: Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006, 355 (20): 2085-2098.CrossRefPubMed
21.
go back to reference Pfeffer MA, Burdmann EA, Chen CY, Cooper ME, de Zeeuw D, Eckardt KU, Feyzi JM, Ivanovich P, Kewalramani R, Levey AS, et al: A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med. 2009, 361 (21): 2019-2032.CrossRefPubMed Pfeffer MA, Burdmann EA, Chen CY, Cooper ME, de Zeeuw D, Eckardt KU, Feyzi JM, Ivanovich P, Kewalramani R, Levey AS, et al: A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med. 2009, 361 (21): 2019-2032.CrossRefPubMed
22.
go back to reference Eknoyan G: Why we need clinical practice guidelines in chronic kidney disease. J Ren Nutr. 2010, 20 (5 Suppl): S127-S130.CrossRefPubMed Eknoyan G: Why we need clinical practice guidelines in chronic kidney disease. J Ren Nutr. 2010, 20 (5 Suppl): S127-S130.CrossRefPubMed
23.
go back to reference Jain AK, McLeod I, Huo C, Cuerden MS, Akbari A, Tonelli M, van Walraven C, Quinn RR, Hemmelgarn B, Oliver MJ, et al: When laboratories report estimated glomerular filtration rates in addition to serum creatinines, nephrology consults increase. Kidney Int. 2009, 76 (3): 318-323.CrossRefPubMed Jain AK, McLeod I, Huo C, Cuerden MS, Akbari A, Tonelli M, van Walraven C, Quinn RR, Hemmelgarn B, Oliver MJ, et al: When laboratories report estimated glomerular filtration rates in addition to serum creatinines, nephrology consults increase. Kidney Int. 2009, 76 (3): 318-323.CrossRefPubMed
24.
go back to reference Wyatt C, Konduri V, Eng J, Rohatgi R: Reporting of estimated GFR in the primary care clinic. Am J Kidney Dis. 2007, 49 (5): 634-641.CrossRefPubMed Wyatt C, Konduri V, Eng J, Rohatgi R: Reporting of estimated GFR in the primary care clinic. Am J Kidney Dis. 2007, 49 (5): 634-641.CrossRefPubMed
25.
go back to reference Patwardhan MB, Kawamoto K, Lobach D, Patel UD, Matchar DB: Recommendations for a clinical decision support for the management of individuals with chronic kidney disease. Clin J Am Soc Nephrol. 2009, 4 (2): 273-283.CrossRefPubMedPubMedCentral Patwardhan MB, Kawamoto K, Lobach D, Patel UD, Matchar DB: Recommendations for a clinical decision support for the management of individuals with chronic kidney disease. Clin J Am Soc Nephrol. 2009, 4 (2): 273-283.CrossRefPubMedPubMedCentral
26.
go back to reference Jha AK, Perlin JB, Kizer KW, Dudley RA: Effect of the transformation of the Veterans Affairs Health Care System on the quality of care. N Engl J Med. 2003, 348 (22): 2218-2227.CrossRefPubMed Jha AK, Perlin JB, Kizer KW, Dudley RA: Effect of the transformation of the Veterans Affairs Health Care System on the quality of care. N Engl J Med. 2003, 348 (22): 2218-2227.CrossRefPubMed
27.
go back to reference Matchar DB, Patwardhan MB, Samsa GP, Haley WE: Facilitated process improvement: an approach to the seamless linkage between evidence and practice in CKD. Am J Kidney Dis. 2006, 47 (3): 528-538.CrossRefPubMed Matchar DB, Patwardhan MB, Samsa GP, Haley WE: Facilitated process improvement: an approach to the seamless linkage between evidence and practice in CKD. Am J Kidney Dis. 2006, 47 (3): 528-538.CrossRefPubMed
28.
go back to reference How to utilize RPA’s Advanced CKD Patient Management Toolkit. Renal Physicians Association. 2012 How to utilize RPA’s Advanced CKD Patient Management Toolkit. Renal Physicians Association. 2012
29.
go back to reference Stevens PE, de Lusignan S, Farmer CK, Tomson CR: Engaging primary care in CKD initiatives: the UK experience. Nephrol Dial Transplant. 2012, 27 (Suppl 3): iii5-iii11.CrossRefPubMed Stevens PE, de Lusignan S, Farmer CK, Tomson CR: Engaging primary care in CKD initiatives: the UK experience. Nephrol Dial Transplant. 2012, 27 (Suppl 3): iii5-iii11.CrossRefPubMed
Metadata
Title
Perceptions and use of the national kidney foundation KDOQI guidelines: a survey of U.S. renal healthcare providers
Authors
Michelle M Estrella
Bernard G Jaar
Kerri L Cavanaugh
Chester H Fox
Mark A Perazella
Sandeep S Soman
Emily Howell
Michael V Rocco
Michael J Choi
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2013
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/1471-2369-14-230

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