Knowledge and Approaches of Family Physicians on Chronic Kidney Disease Screening, Diagnosis and Follow-up According to the 2024 Kidney Disease: Improving Global Outcomes (KDIGO) Guidelines

Pemra C. Unalan, Fevzi Kaya, Buğu Usanma Koban, Pınar Kocabas

Keywords: chronic renal disease, primary care, preventive care, practice guideline

Background:

Chronic Kidney Disease (CKD) is frequently asymptomatic in its early stages but progresses to high morbidity and mortality when diagnosed in its later phases. Serum creatinine and urine albumin tests are available in family health centers (FHCs) for screening.

Research questions:

What is the knowledge and approaches of family physicians working in primary care regarding CKD screening, prevention, diagnosis, and treatment in accordance with evidence-based international guidelines?

Method:

This cross-sectional descriptive study was conducted among family physicians employed at FHCs in eight of the most densely populated districts of Istanbul. A sample size representative of this population was calculated and a face-to-face, 51-item questionnaire which was developed on relevant literature and the 2024 Kidney Disease: Improving Global Outcomes (KDIGO) Guidelines was administered through a random sampling from FHCs within each district. Descriptive statistics were presented as percentages, and means. Chi-square tests were used for categorical variables, while T-tests and Mann-Whitney U tests were applied for continuous variables and independent groups. Statistical significance was defined as p<0.05.

Results:

Of the 302 participants, 171 were female (56.6%) and 131 were male (43.4%). The mean age was 35±9.96 (min:26, max:66). Among the participants, 58.6% (n=177) were general practitioners while 41.4% (n=125) were family medicine specialists or trainees. It was observed that younger physicians, trainees, and those with ≤3000 registered patients had significantly higher rates of knowledge about the recommended frequency of proteinuria screening in diabetes and hypertension patients (p=0.01, p<0.001, and p=0.034 respectively). Family medicine specialists and full-time residents had significantly higher total scores on the CKD knowledge scale, attitude-approach scale, and KDIGO diagnostic criteria compared to GPs (all p<0.001).

Conclusions:

Primary care physicians who are specialist or trainees, younger practitioners and those with fewer registered patients, have more current evidence-based knowledge and approaches regarding the screening, diagnosis and follow-up of CKD to effectively prevent and manage it.

Points for discussion:

Do you have a structured training program in your country about guidelines?

What kind of sources are used for evidence based medicine by general practitioners in your country? Do you have national guidelines?

What is your experience about the problems that make it difficult to use evidence based screening and follow-up of chronic diseases in primary care in your country?

#196