Nationwide questionnaire survey on the management of chronic kidney disease for general practitioners in Japan

"The Disease Awareness Innovation Network" for chronic kidney disease identification in general practice

BACKGROUND

The "awareness gap" and the under-recognition of chronic kidney disease (CKD) by general practitioners (GPs) is well documented. We set a framework to evaluate the impact in primary care of targeted training and networking with nephrologists with regard to CKD awareness in terms of potential increase of the proportion of patients classified according to KDIGO in the general population and in patients with diabetes, hypertension and heart failure.

METHODS

Data were extracted from the Millewin Digital Platform in use by the GPs (N = 17) at baseline (T0, N = 17,854) and after 6 months (T6, N = 18,662) of networking (education, instant messaging and selected joint visits) with nephrologists (N = 2). The following variables were extracted: age, sex, eGFR (estimated glomerular filtration rate), ACR (urinary albumin-to-creatinine ratio), presence of type 2 diabetes, hypertension and heart failure. The proportion of patients detected having an eGFR below 60 mL/min/1.73m² was also reported as deemed clinically relevant.

RESULTS

We observed an increase in the use of ACR and eGFR tests in the entire cohort (+ 121% and + 73%, respectively) and in patients with comorbidities. The proportion of patients with eGFR < 60 mL/min/1.73m² significantly increased from 2.2% to 3.8% in the entire cohort,  from 6.3% to 12.7% in patients with diabetes, and from 5.6% to 9.9% in those with hypertension and finally from 10.8% to 23.7% in patients with heart failure.

CONCLUSIONS

Training and network support to GPs by nephrologists can improve CKD awareness and increase its identification in the general population and, even more, in categories at risk.