Identification and management of chronic kidney disease complications by internal medicine residents: A national survey

Varun Agrawal, Mohit Agarwal, Amit Ghosh, Michael A. Barnes, Peter A. McCullough

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

Many patients with chronic kidney disease (CKD) receive care from primary care physicians. Identification and management of CKD complications in primary care is suboptimal. It is not known if current residency curriculum adequately prepares a future internist in this aspect of CKD care. We performed an online questionnaire survey of internal medicine residents in the United States to determine knowledge of CKD complications and their management. Four hundred seventy-nine residents completed the survey with postgraduate year (PGY) distribution 166 PGY1, 187 PGY2, and 126 PGY3. Most of the residents correctly recognized anemia (91%) and bone disease (82%) as complications at estimated glomerular filtration rate less than 60 mL/min/1.73 m 2; however, only half of the residents identified coronary artery disease (54%) as a CKD complication. For a patient with estimated glomerular filtration rate less than 60 mL/min/1.73 m 2, two thirds of the residents would workup for anemia (62%), whereas half of them would check for mineral and bone disorder (56%). With regard to anemia of CKD, less than half of the residents knew the CKD goal hemoglobin level of 11 to 12 g/dL (44%); most would supplement iron stores (86%), whereas fewer would consider nephrology referral (28%). For mineral and bone disorders, many residents would recommend dietary phosphorus restriction (68%) and check 25-hydroxyvitamin D (62%); fewer residents would start 1,25-dihydroxyvitamin D (40%) or refer to the nephrologist (45%). Residents chose to discontinue angiotensin-converting enzyme inhibitor for medication-related complication of greater than 50% decline in estimated glomerular filtration rate (68%) and potassium greater than 5.5 mEq/L (93%). Mean performance score improved with increasing PGY (PGY1 59.4% ± 17.6%, PGY2 63.6% ± 15.6%, and PGY3 66.2% ± 16.5%; P = 0.002). Our study identified specific gaps in knowledge of CKD complications and management among internal medicine residents. Educational efforts such as instruction on use of CKD clinical practice guidelines may help raise awareness of CKD complications, benefits of early intervention, and improve CKD management.

Original languageEnglish (US)
JournalAmerican Journal of Therapeutics
Volume18
Issue number3
DOIs
StatePublished - May 2011

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Internal Medicine
Chronic Renal Insufficiency
Glomerular Filtration Rate
Anemia
Disease Management
Minerals
Surveys and Questionnaires
Dietary Phosphorus
Bone and Bones
Nephrology
Bone Diseases
Primary Care Physicians
Internship and Residency
Practice Guidelines
Angiotensin-Converting Enzyme Inhibitors
Curriculum
Coronary Artery Disease
Primary Health Care
Potassium
Hemoglobins

Keywords

  • anemia
  • chronic kidney disease
  • complications
  • internal medicine residency
  • mineral and bone disorder

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Identification and management of chronic kidney disease complications by internal medicine residents : A national survey. / Agrawal, Varun; Agarwal, Mohit; Ghosh, Amit; Barnes, Michael A.; McCullough, Peter A.

In: American Journal of Therapeutics, Vol. 18, No. 3, 05.2011.

Research output: Contribution to journalReview article

Agrawal, Varun ; Agarwal, Mohit ; Ghosh, Amit ; Barnes, Michael A. ; McCullough, Peter A. / Identification and management of chronic kidney disease complications by internal medicine residents : A national survey. In: American Journal of Therapeutics. 2011 ; Vol. 18, No. 3.
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