Awareness and Knowledge of Clinical Practice Guidelines for CKD Among Internal Medicine Residents: A National Online Survey

Background

The National Kidney Foundation published Kidney Disease Outcomes Quality Initiative guidelines that recommend early detection and management of chronic kidney disease (CKD) and timely referral to a nephrologist. Many patients with CKD are seen by primary care physicians who are less experienced than nephrologists to offer optimal pre–end-stage renal disease care. It is not known whether current postgraduate training adequately prepares a future internist in CKD management.

Study Design

Cross-sectional study using an online questionnaire survey.

Setting & Participants

Internal medicine residents in the United States (n = 479) with postgraduate year (PGY) distribution of 166 PGY1, 187 PGY2, and 126 PGY3.

Predictor

Awareness and knowledge of CKD clinical practice guidelines measured by using the questionnaire instrument.

Outcomes & Measurements

Total performance score (maximum = 30).

Results

Half the residents did not know that the presence of kidney damage (proteinuria) for 3 or more months defines CKD. One-third of the residents did not know the staging of CKD. All residents (99%) knew the traditional risk factors for CKD of diabetes and hypertension, but were less aware of other risk factors of obesity (38%), elderly age (71%), and African American race (68%). Most residents (87%) were aware of estimated glomerular filtration rate in the evaluation of patients with CKD. Most residents (90%) knew goal blood pressure (<130/80 mm Hg) for patients with CKD. Most residents identified anemia (91%) and bone disorder (82%) as complications of CKD, but only half recognized CKD as a risk factor for cardiovascular disease. Most residents (90%) chose to refer a patient with a glomerular filtration rate less than 30 mL/min/1.73 m² to a nephrologist. A small improvement in mean performance score was observed with increasing PGY (PGY1, 68.8% ± 15.4%; PGY2, 72.9% ± 14.7%; and PGY3, 74.0% ± 12.0%; P = 0.004).

Limitations

Self-selection, lack of nonrespondent data.

Conclusions

Our survey identified specific gaps in knowledge of CKD guidelines in internal medicine residents. Educational efforts in increasing awareness of these guidelines may improve CKD management and clinical outcomes.

Index Words: Chronic kidney disease, practice guidelines, internal medicine residency, graduate medical education, questionnaire