American Journal of Kidney Diseases
Volume 54, Issue 2 , Pages 227-237 , August 2009

Clinical Testing Patterns and Cost Implications of Variation in the Evaluation of CKD Among US Physicians

  • Raquel F. Charles, MD, MHS

      Affiliations

    • Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
    • Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD
    • ,
  • Neil R. Powe, MD, MPH, MBA

      Affiliations

    • Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
    • Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD
    • Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
    • ,
  • Bernard G. Jaar, MD

      Affiliations

    • Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD
    • Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
    • Nephrology Center of Maryland, Baltimore, MD
    • ,
  • Misty U. Troll, MPH

      Affiliations

    • Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
    • Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD
    • ,
  • Rulan S. Parekh, MD

      Affiliations

    • Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD
    • Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
    • Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
    • ,
  • L. Ebony Boulware, MD, MPH

      Affiliations

    • Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
    • Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD
    • Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
    • Corresponding Author InformationAddress correspondence to L. Ebony Boulware, MD, MPH, 2024 E Monument St, Ste 2-624, Baltimore, MD 21205

Received 28 July 2008 ,Accepted 10 December 2008.

References 

  1. Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298:2038–2047
  2. US Renal Data System. USRDS 2007 Annual Data Report. Bethesda, MD: The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2007;
  3. US Renal Data System. USRDS 1997 Annual Data Report. Bethesda, MD: The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 1997;
  4. National Kidney Foundation. KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(suppl 1):S1–S266
  5. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation (Modification of Diet in Renal Disease Study Group). Ann Intern Med. 1999;130:461–470
  6. Centers for Medicare & Medicaid Services. 2005 Clinical Diagnostic Laboratory Fee Schedule. www.cms.hhs.gov/ClinicalLabFeeSched/02_clinlab.asp#TopOfPageAccessed April 1, 2008
  7. Boulware LE, Troll MU, Jaar BG, Myers DI, Powe NR. Identification and referral of patients with progressive CKD: A national study. Am J Kidney Dis. 2006;48:192–204
  8. Johnson SL, Tierney EF, Onyemere KU, et al. Who is tested for diabetic kidney disease and who initiates treatment? (The Translating Research Into Action for Diabetes (TRIAD) Study). Diabetes Care. 2006;29:1733–1738
  9. Israni A, Korzelius C, Townsend R, Mesler D. Management of chronic kidney disease in an academic primary care clinic. Am J Nephrol. 2003;23:47–54
  10. Kausz AT, Khan SS, Abichandani R, et al. Management of patients with chronic renal insufficiency in the Northeastern United States. J Am Soc Nephrol. 2001;12:1501–1507
  11. Lenz O, Fornoni A. Chronic kidney disease care delivered by US family medicine and internal medicine trainees: Results from an online survey. BMC Med. 2006;4:30
  12. Elsayed EF, Tighiouart H, Griffith J, et al. Cardiovascular disease and subsequent kidney disease. Arch Intern Med. 2007;167:1130–1136
  13. Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines? (A framework for improvement). JAMA. 1999;282:1458–1465
  14. Textor S. Atherosclerotic renal artery stenosis: Overtreated but underrated. J Am Soc Nephrol. 2008;19:656–659
  15. Evenepoel P, Zeegers M, Segaert S, et al. Nephrogenic fibrosing dermopathy: A novel, disabling disorder in patients with renal failure. Nephrol Dial Transplant. 2004;19:469–473
  16. Grobner T. Gadolinium: A specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis?. Nephrol Dial Transplant. 2006;21:1104–1108
  17. Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Ann Intern Med. 2003;139:137–147
  18. Johnson CA, Levey AS, Coresh J, Levin A, Lau J, Eknoyan G. Clinical practice guidelines for chronic kidney disease in adults: Part I (Definition, disease stages, evaluation, treatment, and risk factors). Am Fam Physician. 2004;70:869–876
  19. Snyder S, Pendergraph B. Detection and evaluation of chronic kidney disease. Am Fam Physician. 2005;72:1723–1732
  20. Lea JP, McClellan WM, Melcher C, Gladstone E, Hostetter T. CKD risk factors reported by primary care physicians: Do guidelines make a difference?. Am J Kidney Dis. 2006;47:72–77

 Originally published online as doi: 10.1053/j.ajkd.2008.12.044 on April 16, 2009.

 Because the Editor-in-Chief recused himself from consideration of this manuscript, the Deputy Editor (Daniel E. Weiner, MD, MS) served as Acting Editor-in-Chief. Details of the journal's procedures for potential editor conflicts are given in the Editorial Policies section of the AJKD website.

PII: S0272-6386(09)00429-6

doi: 10.1053/j.ajkd.2008.12.044

American Journal of Kidney Diseases
Volume 54, Issue 2 , Pages 227-237 , August 2009

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