- 期刊
- OpenAccess
Survey on Non-Nephrologists' Knowledge of Chronic Kidney Disease Diagnosis and Care in a Tertiary Hospital
並列摘要
BACKGROUND: Taiwan has a high prevalence (11.9% in 2010) of chronic kidney disease (CKD). To prevent CKD from progressing to end-stage renal disease (ESRD), early diagnosis of CKD and timely referral to nephrologists are crucial. The aim of this study was to investigate non-nephrologists' knowledge of CKD diagnosis and care in this hospital.METHODS: A written questionnaire was developed to evaluate non-nephrologists' knowledge of CKD screening, diagnostic criteria, evaluation, complication assessment and management, and nephrology referral. The questionnaires were distributed to attending physicians in diverse clinical specialties at our hospital. The chi-square test was employed to detect any differences in categorical data. Proportions were calculated for each answer category and expressed as percentages.RESULTS: Eighty-two questionnaires were distributed; 65 questionnaires were returned, yielding a response rate of 79%. Respondents included internists, 56.92%; family medicine physicians, 9.23%; surgeons, 32.31%; and other specialists, 1.54%. Less than half the participants (45.31%) were aware of the kidney care educational clinic at our hospital. Almost 20% of respondents indicated they would not order a urine test for proteinuria in patients at high risk for CKD. A significantly higher percentage of non-internal medicine physicians than internal medicine physicians (36.36% vs. 9.30%, P ＜ 0.01) indicated they would not order a urine test for proteinuria for patients at high risk for CKD. Only half the respondents chose GFR as the main diagnostic criterion for CKD and as the indicator for assessing the severity of CKD. A large percentage of participants (46%) would not order an iPTH, Ca, or P test for CKD patients. Only 18.33% of respondents indicated they would not stop ACEI/ARB therapy in patients with CKD according to creatinine levels. Almost 30% of participants chose the incorrect higher LDL target levels for CKD patients. Less than half the participants knew the correct blood pressure target for CKD patients. The percentages of respondents who would not use creatinine levels, eGFR, proteinuria, or creatinine changes as indications for nephrology referral were approximately 20%, 34%, 40%, and 30%, respectively. Internal medicine physicians showed significantly different responses from non-internal medicine physicians to the questions on proteinuria level as an indication for nephrology referral (P ＜ 0.05).CONCLUSION: Non-nephrologists in this tertiary hospital have insufficient knowledge of CKD diagnosis, complication management, interventions for slowing disease progression, and criteria for nephrology referral. Compared with their internal medicine counterparts, non-internal medicine physicians have even poorer knowledge of CKD screening, prevention and management of complications, and nephrology referral.