Abstract: SA-PO925

Knowledge and Practice Patterns in the Diagnosis, Evaluation, and Management of Mineral Bone Disease in CKD among Primary Care Physicians and Nephrologists

Session Information

  • Educational Research
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Nephrology Education

  • 1301 Educational Research

Authors

  • Schreiber, Brittany Lauren, University of Texas Medical Branch, Galveston, Texas, United States
  • Espinoza, Flor, University of Texas Medical Branch, Galveston, Texas, United States
  • Aleter, Omar A., University of Texas Medical Branch, Galveston, Texas, United States
  • Kassem, Hania, University of Texas Medical Branch, Galveston, Texas, United States
Background

Mineral bone disease in chronic kidney disease (CKD-MBD) is a systemic disorder encompassing mineral, bone, and calcific cardiovascular abnormalities that develop as a complication of CKD and contribute to morbidity and mortality in these patients. Despite the availability of guidelines, there continues to be a disparity in practice patterns contributing to therapeutic inertia. Our aim was to identify gaps in knowledge and variations in clinical practice among primary care providers in comparison to nephrologists regarding the diagnosis, evaluation and management of CKD-MBD especially in earlier stages of CKD when patients might not be followed by a nephrologist.

Methods

This study was conducted using a questionnaire which was distributed to residents, fellows and faculty in primary care specialties and nephrology. Questions were derived from the 2009 practice guidelines from the Kidney Disease Improving Global Outcomes work group and the 2003 National Kidney Foundation's Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease.

Results

Nephrologists scored higher than primary care physicians in all areas tested including pathophysiology of the disease, screening parameters and intervals, target levels and treatment strategies. The difference in score was statistically significant in the majority of those areas. Overall, primary care specialists (n of 51) scored an average of 31.7 % while nephrologists (n of 11) scored an average of 80.3 % (p-value <0.01).

Conclusion

Our investigation showed there is a significant discrepancy in knowledge between primary care physicians and nephrologists regarding diagnosis and management of CKD-MBD. It is necessary to improve primary care physicians' knowledge and practice in this field to provide high quality of care to patients. Our next steps include physician education and creation of best practice advisory alerts using the electronic medical record system which will include criteria for appropriate nephrology referral for this subset of patients.