Physician Characteristics and Knowledge of CKD Management

Background: Many studies suggest that chronic kidney disease (CKD) care is suboptimal in the United States. However, it is not known whether knowledge of CKD management in primary care physicians (PCPs) might have an important role in the suboptimal care and whether PCP characteristics are associated with having adequate knowledge. Study Design: Cross-sectional study. Setting & Participants: Self-administered questionnaire sent to a random sample of 1,550 US PCPs in February 2007. Predictor or Factor: PCP characteristics, including age, sex, degree (MD versus DO), primary specialty, board certification, patient volume, percentage of time in patient care spent in the inpatient versus outpatient setting, and number of patients referred to nephrologists in a month. Outcomes & Measurements: Regression analyses of the association between physician characteristics and overall physician knowledge of CKD management, as well as individual subdomains of CKD knowledge related to recognition of CKD and management of hypertension in the setting of CKD. Results: 470 of 1,453 (32.4%) eligible PCPs returned a completed survey. PCPs show significant variation in their ability to recognize CKD stages 2 to 4, but most have appropriate blood pressure goals in patients with CKD and are knowledgeable of the role of angiotensin-converting enzyme inhibitors in managing proteinuria. For each 10-year increase in age, the odds of showing satisfactory knowledge of CKD management decreased by 26% (odds ratio, 0.74; 95% confidence interval, 0.60 to 0.92). PCPs with the primary specialty of internal medicine had a more than 3-fold greater odds of showing a satisfactory level of knowledge compared with family practice specialists (odds ratio, 3.40; 95% confidence interval, 2.17 to 5.32). Limitations: The study findings are limited by the potential presence of nonresponse bias, information bias, and results suggesting there are multiple knowledge subdomains that perhaps are not additive. Conclusion: There is need to improve CKD knowledge in PCPs, especially regarding recognition of CKD at an early stage. Am J Kidney Dis 54:238-247. (C) 2009 by the National Kidney Foundation, Inc.