Cardiovascular risk management in chronic kidney disease in general practice (the AusHEART study)

Mona Razavian, Emma Heeley, Vlado Perkovic, Sophia Zoungas, Andrew Weekes, Anushka Patel, Craig Anderson, John Chalmers, Alan Cass

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Chronic kidney disease (CKD) is common and increasing in prevalence. Adverse outcomes of CKD can be prevented through early detection and treatment. There is limited data on the awareness of CKD and the quality of care offered to patients with CKD in the primary care setting. The objectives of this study were to assess the prevalence, general practitioner (GP) awareness and extent of current evidence–practice gaps in the management of CKD in Australian primary care.

    Methods: 
    The Australian Hypertension and Absolute Risk Study (AusHEART) was a nationally representative, cluster stratified, cross-sectional survey among 322 GPs. Each GP was asked to provide data for 15–20 consecutive patients (age ≥ 55 years) who presented between April and June, 2008. The main outcome measures were CKD prevalence based on proteinuria and decreased estimated glomerular filtration rate. Evidence–practice gaps in management of patients with CKD were identified.

    Results: 
    Among a total of 4966 patients with kidney function test data, 1845 (37%) had abnormal kidney function. Of the 1312 patients with abnormal kidney function known to the GP at the time of visit, only 235 were correctly identified as having CKD. GPs under-estimated cardiovascular (CV) risks in patients with CKD when compared with the prevailing guidelines at the time of survey and the recent national guidelines, particularly in later stages of CKD. Among CKD patients not prescribed blood pressure-lowering agents or lipid-lowering agents, treatment was indicated as per relevant guidelines in 51 and 46%, respectively. For CKD patients who were already prescribed blood pressure-lowering and lipid-lowering agents, 61 and 50%, respectively, did not meet the treatment targets recommended by the relevant guidelines.

    Conclusions: 
    CKD is common, significantly under-recognized and under-treated in primary care. Effort to increase awareness and provide opportunities for improved screening and assessment should improve the management and outcome of these patients at high risk of CV disease.
    Original languageEnglish
    Pages (from-to)1396-1402
    Number of pages7
    JournalNephrology Dialysis Transplantation
    Volume27
    Issue number4
    DOIs
    Publication statusPublished - 2012

    Fingerprint

    Risk Management
    Chronic Renal Insufficiency
    General Practice
    Hypertension
    Guidelines
    General Practitioners
    Primary Health Care
    Kidney Function Tests
    Blood Pressure
    Kidney
    Lipids
    Quality of Health Care
    Glomerular Filtration Rate
    Proteinuria
    Cardiovascular Diseases
    Therapeutics
    Cross-Sectional Studies
    Outcome Assessment (Health Care)

    Cite this

    Razavian, Mona ; Heeley, Emma ; Perkovic, Vlado ; Zoungas, Sophia ; Weekes, Andrew ; Patel, Anushka ; Anderson, Craig ; Chalmers, John ; Cass, Alan. / Cardiovascular risk management in chronic kidney disease in general practice (the AusHEART study). In: Nephrology Dialysis Transplantation. 2012 ; Vol. 27, No. 4. pp. 1396-1402.
    @article{7ce416eff78d419e9fdebeba02b4df7c,
    title = "Cardiovascular risk management in chronic kidney disease in general practice (the AusHEART study)",
    abstract = "Background: Chronic kidney disease (CKD) is common and increasing in prevalence. Adverse outcomes of CKD can be prevented through early detection and treatment. There is limited data on the awareness of CKD and the quality of care offered to patients with CKD in the primary care setting. The objectives of this study were to assess the prevalence, general practitioner (GP) awareness and extent of current evidence–practice gaps in the management of CKD in Australian primary care.Methods: The Australian Hypertension and Absolute Risk Study (AusHEART) was a nationally representative, cluster stratified, cross-sectional survey among 322 GPs. Each GP was asked to provide data for 15–20 consecutive patients (age ≥ 55 years) who presented between April and June, 2008. The main outcome measures were CKD prevalence based on proteinuria and decreased estimated glomerular filtration rate. Evidence–practice gaps in management of patients with CKD were identified.Results: Among a total of 4966 patients with kidney function test data, 1845 (37{\%}) had abnormal kidney function. Of the 1312 patients with abnormal kidney function known to the GP at the time of visit, only 235 were correctly identified as having CKD. GPs under-estimated cardiovascular (CV) risks in patients with CKD when compared with the prevailing guidelines at the time of survey and the recent national guidelines, particularly in later stages of CKD. Among CKD patients not prescribed blood pressure-lowering agents or lipid-lowering agents, treatment was indicated as per relevant guidelines in 51 and 46{\%}, respectively. For CKD patients who were already prescribed blood pressure-lowering and lipid-lowering agents, 61 and 50{\%}, respectively, did not meet the treatment targets recommended by the relevant guidelines.Conclusions: CKD is common, significantly under-recognized and under-treated in primary care. Effort to increase awareness and provide opportunities for improved screening and assessment should improve the management and outcome of these patients at high risk of CV disease.",
    author = "Mona Razavian and Emma Heeley and Vlado Perkovic and Sophia Zoungas and Andrew Weekes and Anushka Patel and Craig Anderson and John Chalmers and Alan Cass",
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    doi = "10.1093/ndt/gfr599",
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    volume = "27",
    pages = "1396--1402",
    journal = "Nephrology Dialysis Transplantation",
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    Razavian, M, Heeley, E, Perkovic, V, Zoungas, S, Weekes, A, Patel, A, Anderson, C, Chalmers, J & Cass, A 2012, 'Cardiovascular risk management in chronic kidney disease in general practice (the AusHEART study)', Nephrology Dialysis Transplantation, vol. 27, no. 4, pp. 1396-1402. https://doi.org/10.1093/ndt/gfr599

    Cardiovascular risk management in chronic kidney disease in general practice (the AusHEART study). / Razavian, Mona; Heeley, Emma; Perkovic, Vlado; Zoungas, Sophia; Weekes, Andrew; Patel, Anushka; Anderson, Craig; Chalmers, John; Cass, Alan.

    In: Nephrology Dialysis Transplantation, Vol. 27, No. 4, 2012, p. 1396-1402.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Cardiovascular risk management in chronic kidney disease in general practice (the AusHEART study)

    AU - Razavian, Mona

    AU - Heeley, Emma

    AU - Perkovic, Vlado

    AU - Zoungas, Sophia

    AU - Weekes, Andrew

    AU - Patel, Anushka

    AU - Anderson, Craig

    AU - Chalmers, John

    AU - Cass, Alan

    PY - 2012

    Y1 - 2012

    N2 - Background: Chronic kidney disease (CKD) is common and increasing in prevalence. Adverse outcomes of CKD can be prevented through early detection and treatment. There is limited data on the awareness of CKD and the quality of care offered to patients with CKD in the primary care setting. The objectives of this study were to assess the prevalence, general practitioner (GP) awareness and extent of current evidence–practice gaps in the management of CKD in Australian primary care.Methods: The Australian Hypertension and Absolute Risk Study (AusHEART) was a nationally representative, cluster stratified, cross-sectional survey among 322 GPs. Each GP was asked to provide data for 15–20 consecutive patients (age ≥ 55 years) who presented between April and June, 2008. The main outcome measures were CKD prevalence based on proteinuria and decreased estimated glomerular filtration rate. Evidence–practice gaps in management of patients with CKD were identified.Results: Among a total of 4966 patients with kidney function test data, 1845 (37%) had abnormal kidney function. Of the 1312 patients with abnormal kidney function known to the GP at the time of visit, only 235 were correctly identified as having CKD. GPs under-estimated cardiovascular (CV) risks in patients with CKD when compared with the prevailing guidelines at the time of survey and the recent national guidelines, particularly in later stages of CKD. Among CKD patients not prescribed blood pressure-lowering agents or lipid-lowering agents, treatment was indicated as per relevant guidelines in 51 and 46%, respectively. For CKD patients who were already prescribed blood pressure-lowering and lipid-lowering agents, 61 and 50%, respectively, did not meet the treatment targets recommended by the relevant guidelines.Conclusions: CKD is common, significantly under-recognized and under-treated in primary care. Effort to increase awareness and provide opportunities for improved screening and assessment should improve the management and outcome of these patients at high risk of CV disease.

    AB - Background: Chronic kidney disease (CKD) is common and increasing in prevalence. Adverse outcomes of CKD can be prevented through early detection and treatment. There is limited data on the awareness of CKD and the quality of care offered to patients with CKD in the primary care setting. The objectives of this study were to assess the prevalence, general practitioner (GP) awareness and extent of current evidence–practice gaps in the management of CKD in Australian primary care.Methods: The Australian Hypertension and Absolute Risk Study (AusHEART) was a nationally representative, cluster stratified, cross-sectional survey among 322 GPs. Each GP was asked to provide data for 15–20 consecutive patients (age ≥ 55 years) who presented between April and June, 2008. The main outcome measures were CKD prevalence based on proteinuria and decreased estimated glomerular filtration rate. Evidence–practice gaps in management of patients with CKD were identified.Results: Among a total of 4966 patients with kidney function test data, 1845 (37%) had abnormal kidney function. Of the 1312 patients with abnormal kidney function known to the GP at the time of visit, only 235 were correctly identified as having CKD. GPs under-estimated cardiovascular (CV) risks in patients with CKD when compared with the prevailing guidelines at the time of survey and the recent national guidelines, particularly in later stages of CKD. Among CKD patients not prescribed blood pressure-lowering agents or lipid-lowering agents, treatment was indicated as per relevant guidelines in 51 and 46%, respectively. For CKD patients who were already prescribed blood pressure-lowering and lipid-lowering agents, 61 and 50%, respectively, did not meet the treatment targets recommended by the relevant guidelines.Conclusions: CKD is common, significantly under-recognized and under-treated in primary care. Effort to increase awareness and provide opportunities for improved screening and assessment should improve the management and outcome of these patients at high risk of CV disease.

    U2 - 10.1093/ndt/gfr599

    DO - 10.1093/ndt/gfr599

    M3 - Article

    VL - 27

    SP - 1396

    EP - 1402

    JO - Nephrology Dialysis Transplantation

    JF - Nephrology Dialysis Transplantation

    SN - 0931-0509

    IS - 4

    ER -