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Diagnosis and referrals for kidney disease fall well short of need, Johns Hopkins study shows

Results of a national study of 304 U.S. physicians, in which "mock" patients' symptoms were presented for diagnosis, suggest that a sizeable percentage of primary care doctors probably fail to properly diagnose and refer patients with chronic kidney disease (CKD).

Their findings, reported in the August issue of the American Journal of Kidney Diseases, show that of 126 kidney specialists surveyed, 97 percent properly diagnosed CKD and 99 percent would have recommended specialized kidney care for the "patient." But only 59 percent of the 89 family physicians and 78 percent of 89 general internal medicine physicians fully recognized the signs and symptoms of CKD. And referrals to a nephrologist were made by only 76 percent of the family physicians and only 81 percent of general internists.

"We, as physicians, can certainly do better," says L. Ebony Boulware, M.D., Assistant Professor of Medicine at The Johns Hopkins University School of Medicine, and lead author of the study.

"Millions of people have kidney disease, but a substantial number may not have their disease recognized," Boulware added. "Simply put, our study shows that primary care physicians are not recognizing kidney disease in high-risk patients as often as they should."

In the study, the Hopkins group asked the surveyed physicians to evaluate the medical files of a simulated patient being treated by a primary-care doctor and suffering from progressive CKD. CKD is a growing epidemic, affecting an estimated 10 million Americans. The medical "record" contained clues to the condition indicating that, based on guidelines issued in 2000 by the National Kidney Foundation, the patient should be referred to a nephrologist for evaluation of CKD.

CKD is characterized by the progressive loss of renal function over a period of months or years. Signs include an abnormally low glomerular filtration rate, a standard measurement of renal health. The severe form of th
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Contact: Jeff Ventura
jventur4@jhmi.edu
410-955-7832
Johns Hopkins Medical Institutions
31-Jul-2006


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