Abstract: FR-PO318
The KDIGO 2012 CKD Classification System Improves Physician Recognition and Management of Kidney Disease: A Randomized Vignette Study
Session Information
- CKD: Clinical, Outcomes, Trials - II
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Hallan, Stein I., NTNU, Trondheim, Norway
- Rifkin, Dena E., UCSD, San Diego, California, United States
- Potok, O. Alison, UCSD, San Diego, California, United States
- Langlo, Knut Asbjørn Rise, St. Olavs Hospital HF, Trondheim, Norway
- Dekker, Friedo W., Leiden University Medical Center, Leiden, Netherlands
- Ix, Joachim H., UCSD, San Diego, California, United States
Background
Chronic kidney disease (CKD) is common worldwide with high morbidity and mortality rates. New international guidelines based on estimated glomerular filtration rate (eGFR) versus albuminuria were introduced 2012 to help with diagnosis, classification, referral, and treatment, but their clinical utility has not been evaluated. We therefore wanted to determine if KDIGO guideline helps physicians recognize and appropriately care for CKD patients.
Methods
We conducted a randomized vignette experiment with fractional factorial design based on 6 kidney-related scenarios and 3 laboratory presentation methods reflecting the KDIGO guideline. Participants evaluated one of three subsets of the 18 vignettes (i.e. 6 vignettes each with 4 answer alternatives). Kidney related results (serum creatinine and urine albumin) were presented as the “Old” (high/low levels), “Modern” (eGFR reported automatically), or “Future” (eGFR + albuminuria categorization + risk for complications = full 2012 KDIGO classification) laboratory report. Logistic regression modelled correct CKD management with laboratory presentation technique, clinical scenario, and other physician covariates. We included 249 interns, general practitioners, and residents/fellows from Norway and the US participating in post-graduate meetings and courses provided to physicians in training.
Results
When kidney laboratory data was presented as the “Modern report” (automatic eGFR calculation), there was a significantly higher probability for correct patient management compared to the “Old report” (OR 1.57, p<0.0001). Additional significant improvement was obtained with the “Future report” (OR 2.28 for correct answer, p<0.001 vs. “Old report”; OR 1.45, p=0.005 vs. “Modern report”). The 2012 KDIGO classification system improved physician management in 4 of the 6 clinical scenarios covering a wide range of kidney-related topics. Interaction analysis showed that GPs and those with 1-3 years of internal medicine experience had the strongest improvements with the new presentation techniques
Conclusion
Automatic GFR estimation, albuminuria categorization, and notification of the associated risk for complications improve most physicians` recognition and management of a wide range of CKD clinical scenarios.
Funding
- Government Support - Non-U.S.