Chronic Kidney Disease: Physicians' Views and Approaches

BackgroundThe prevalence of chronic kidney disease (CKD) is rising worldwide. The global population of end-stage renal disease (ESRD) patients continues to grow at a rate of 7% per annum. Community-based prevalence rates are not available in India. At the time of presentation to physicians, most CKD patients already have ESRD. Progression of the disease is slow initially, but becomes exponential in the later phases. The time period before ESRD is reached is an opportunity to retard disease progression, but it is generally not exploited. For early diagnosis and involvement of nephrologists in the early stages of CKD, the role of physicians is crucial. Here, we studied physicians' views on CKD and related issues.MethodsA cross-sectional, self-administered, questionnaire-based survey of 104 physicians working in Delhi was carried out between March and July 2004. The respondents were trained in internal medicine. Nephrologists and physicians working in nephrology units were excluded. The questionnaire consisted of 14 open-ended questions under the following subheadings: magnitude of the problem, treatment facilities, treatment costs, constraints, markers, and referrals.ResultsPhysicians' information on the magnitude of the problem was vague, but they felt that CKD would assume public health significance. Renal replacement therapy was the preferred mode of treatment, although its cost was considered to be unaffordable by most patients. About 41% of respondents identified glomerular filtration rate (GFR) as the ideal marker, while 38% of respondents identified serum creatinine level as the ideal marker, ignoring its limitations.ConclusionRespondents recognized the impending epidemic of CKD; however, their knowledge on the natural history of the disease, markers and therapies was inadequate and needs strengthening. Serum creatinine is a good screening test, but has limitations. GFR is the preferred measure, but also involves considerable effort and time, and is costly. In view of these, in settings with limited resources such as India, efforts should be made to use the available nomograms and mathematical formulae to predict GFR based on serum creatinine. Whenever serum creatinine measurements are requested, the routine report should also include the derived GFR, which would help in the early diagnosis of CKD.