Challenges of conducting kidney health checks among patients at risk of chronic kidney disease and attending an urban Aboriginal and Torres Strait Islander primary healthcare service
Prabha Lakhan A B * , Anna Cooney A , Dharmenaan Palamuthusingam C , Gary Torrens D , Geoffrey Spurling A E , Antonio Martinez F and David Johnson G H IA Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, Inala, Qld 4077, Australia.
B The University of Queensland, Poche Centre for Indigenous Health, Brisbane, Qld 4067, Australia.
C Metro North Kidney Health Service, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, Qld 4029, Australia.
D Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia.
E The University of Queensland, Primary Care Clinical Unit, Level 8, Health Sciences Building, Building 16/910, Royal Brisbane and Women's Hospital, Herston, Qld 4029, Australia.
F Mount Isa Hospital, 30 Camooweal Street, Mount Isa, Qld 4825, Australia.
G Department of Nephrology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia.
H Centre for Kidney Disease Research, University of Queensland, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia.
I Translational Research Institute, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia.
Australian Journal of Primary Health 28(5) 371-379 https://doi.org/10.1071/PY21248
Submitted: 28 October 2021 Accepted: 14 February 2022 Published: 22 July 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University.
Abstract
Background: The increasing incidence of chronic kidney disease (CKD) globally highlights the importance of early targeted screening of at-risk persons in primary healthcare settings. This study investigated the early detection of CKD among Aboriginal and Torres Strait Islander patients attending an urban primary healthcare service.
Methods: Routine data extracted for all patients with an active electronic medical record on 7 December 2017 were used to identify patients who were eligible to have a kidney health check (KHC), comprising estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (UACR) tests. A subsequent manual search of electronic health records identified the presence of CKD risk factors and follow-up KHCs.
Results: Of the 1181 eligible patients, 171 (15%) had a complete initial KHC. Of the eight patients with an initial abnormal eGFR, two (25%) had a repeat eGFR assessment within 3 months to confirm the presence of CKD. Of the 30 patients who had an initial abnormal UACR result, three (10%) had at least one repeat UACR measurement within 3 months. In patients with diabetes and/or hypertension and a normal initial KHC, 51% had a repeat eGFR and 36% had UACR within the recommended time frame of 12 months. Similar findings were observed for the recommended time frame of 24 months in patients without diabetes or hypertension.
Conclusion: Accurate documentation of risk factors for CKD and processes to address the barriers to implementation of Kidney Health Australia guidelines will assist in preventing or delaying progression of CKD.
Keywords: chronic kidney disease, early detection, primary health care.
References
Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander Health Survey: Biomedical results, 2012-2013. (Australian Bureau of Statistics: Canberra, ACT, Australia) Available at https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0032012-13?OpenDocument [Verified 16 July 2021]Australian Institute of Health and Welfare (2020) Profiles of Aboriginal and Torres Strait Islander people with kidney disease. Cat. no. IHW 229. (AIHW: Canberra) Available at https://www.aihw.gov.au/getmedia/ca29cd5a-a0f8-46a7-84af-698675002175/aihw-ihw-229.pdf.aspx?inline=true [Verified 16 July 2021]
Barr EL, Barzi F, Hughes JT, Jerums G, O’Dea K, Brown AD, Ekinci EI, Jones GR, Lawton PD, Sinha A, MacIsaac RJ, Cass A, Maple-Brown LJ (2018) Contribution of cardiometabolic risk factors to estimated glomerular filtration rate decline in Indigenous Australians with and without albuminuria - the eGFR Follow-up Study. Nephrology (Carlton, Vic.) 23, 682–689.
| Contribution of cardiometabolic risk factors to estimated glomerular filtration rate decline in Indigenous Australians with and without albuminuria - the eGFR Follow-up Study.Crossref | GoogleScholarGoogle Scholar |
Barrett E, Salem L, Wilson S, O’Neill C, Davis K, Bagnulo S (2015) Chronic kidney disease in an Aboriginal population: A nurse practitioner-led approach to management. Australian Journal of Rural Health 23, 318–321.
| Chronic kidney disease in an Aboriginal population: A nurse practitioner-led approach to management.Crossref | GoogleScholarGoogle Scholar |
Cass A, Cunningham J, Snelling P, Wang Z, Hoy W (2004) Exploring the pathways leading from disadvantage to end-stage renal disease for indigenous Australians. Social Science and Medicine 58, 767–785.
| Exploring the pathways leading from disadvantage to end-stage renal disease for indigenous Australians.Crossref | GoogleScholarGoogle Scholar |
Chadban SJ, Briganti EM, Kerr PG, Dunstan DW, Welborn TA, Zimmet PZ, Atkins RC (2003) Prevalence of kidney damage in Australian adults: The AusDiab kidney study. Journal of the American Society of Nephrology 14, S131–S138.
| Prevalence of kidney damage in Australian adults: The AusDiab kidney study.Crossref | GoogleScholarGoogle Scholar |
Hoy WE, Wang Z, vanBuynder P, Baker PRA, Mathews JD (2001) The natural history of renal disease in Australian Aborigines. Part 1. Changes in albuminuria and glomerular filtration rate over time. Kidney International 60, 243–248.
| The natural history of renal disease in Australian Aborigines. Part 1. Changes in albuminuria and glomerular filtration rate over time.Crossref | GoogleScholarGoogle Scholar |
Hoy WE, Mott SA, McDonald SP (2020) An update on chronic kidney disease in Aboriginal Australians. Clinical Nephrology 93, 124–128.
| An update on chronic kidney disease in Aboriginal Australians.Crossref | GoogleScholarGoogle Scholar |
Jager KJ, Kovesdy C, Langham R, Rosenberg M, Jha V, Zoccali C (2019) A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases. Kidney International 96, 1048–1050.
| A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases.Crossref | GoogleScholarGoogle Scholar |
Johnson DW, Atai E, Chan M, Phoon RK, Scott C, Toussaint ND, Turner GL, Usherwood T, Wiggins KJ (2013) KHA-CARI guideline: Early chronic kidney disease: detection, prevention and management. Nephrology (Carlton, Vic.) 18, 340–350.
| KHA-CARI guideline: Early chronic kidney disease: detection, prevention and management.Crossref | GoogleScholarGoogle Scholar |
Kidney Health Australia (2020) ‘Chronic Kidney Disease (CKD) Management in Primary Care’, 4th edn. (Kidney Health Australia: Melbourne, Vic., Australia) Available at https://kidney.org.au/uploads/resources/CKD-Management-in-Primary-Care_handbook_2020.1.pdf [Verified 5 August 2020]
Lezaic V, Marinkovic J, Milutinovic Z, Jovanovic-Vasiljevic N, Vujicic V, Pejovic B, Kalabic S, Djukanovic L (2018) Recording blood pressure and eGFR in primary care after the Belgrade screening study. Renal Failure 40, 160–169.
| Recording blood pressure and eGFR in primary care after the Belgrade screening study.Crossref | GoogleScholarGoogle Scholar |
Litvin CB, Nietert PJ, Jenkins RG, Wessell AM, Nemeth LS, Ornstein SM (2020) Translating CKD Research into Primary Care Practice: a Group-Randomized Study. Journal of General Internal Medicine 35, 1435–1443.
| Translating CKD Research into Primary Care Practice: a Group-Randomized Study.Crossref | GoogleScholarGoogle Scholar |
Maple-Brown LJ, Hughes JT, Ritte R, Barzi F, Hoy WE, Lawton PD, Jones GRD, Death E, Simmonds A, Sinha AK, Cherian S, Thomas MAB, McDermott R, Brown ADH, O’Dea K, Jerums G, Cass A, MacIsaac RJ (2016) Progression of Kidney Disease in Indigenous Australians: The eGFR Follow-up Study. Clinical Journal of the American Society of Nephrology 11, 993–1004.
| Progression of Kidney Disease in Indigenous Australians: The eGFR Follow-up Study.Crossref | GoogleScholarGoogle Scholar |
Mathew T, Corso O (2009) Review article: Early detection of chronic kidney disease in Australia: which way to go? Nephrology (Carlton, Vic.) 14, 367–373.
| Review article: Early detection of chronic kidney disease in Australia: which way to go?Crossref | GoogleScholarGoogle Scholar |
Neale EP, Middleton J, Lambert K (2020) Barriers and enablers to detection and management of chronic kidney disease in primary healthcare: a systematic review. BMC Nephrology 21, 83
| Barriers and enablers to detection and management of chronic kidney disease in primary healthcare: a systematic review.Crossref | GoogleScholarGoogle Scholar |
Pefanis A, Botlero R, Langham RG, Nelson CL (2018) eMAP:CKD: electronic diagnosis and management assistance to primary care in chronic kidney disease. Nephrology, Dialysis, Transplantation 33, 121–128.
| eMAP:CKD: electronic diagnosis and management assistance to primary care in chronic kidney disease.Crossref | GoogleScholarGoogle Scholar |
Shahinian VB, Saran R (2010) The role of primary care in the management of the chronic kidney disease population. Advances in Chronic Kidney Disease 17, 246–53.
| The role of primary care in the management of the chronic kidney disease population.Crossref | GoogleScholarGoogle Scholar |
Shlipak MG, Tummalapalli SL, Boulware LE, Grams ME, Ix JH, Jha V, Kengne AP, Madero M, Mihaylova B, Tangri N, Cheung M, Jadoul M, Winkelmayer WC, Zoungas S (2021) The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney International 99, 34–47.
| The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.Crossref | GoogleScholarGoogle Scholar |
Sinclair PM, Kable A, Levett-Jones T, Holder C, Oldmeadow CJ (2019) The CKD-DETECT study: An RCT aimed at improving intention to initiate a kidney health check in Australian practice nurses. Journal of Clinical Nursing 28, 2745–2759.
| The CKD-DETECT study: An RCT aimed at improving intention to initiate a kidney health check in Australian practice nurses.Crossref | GoogleScholarGoogle Scholar |
Spurling GK, Askew DA, Schluter PJ, Hayman NE (2013) Implementing computerised Aboriginal and Torres Strait Islander health checks in primary care for clinical care and research: a process evaluation. BMC Medical Informatics and Decision Making 13, 108
| Implementing computerised Aboriginal and Torres Strait Islander health checks in primary care for clinical care and research: a process evaluation.Crossref | GoogleScholarGoogle Scholar |
Tuttle KR, Alicic RZ, Duru OK, Jones CR, Daratha KB, Nicholas SB, McPherson SM, Neumiller JJ, Bell DS, Mangione CM, Norris KC (2019) Clinical Characteristics of and Risk Factors for Chronic Kidney Disease Among Adults and Children: An Analysis of the CURE-CKD Registry. JAMA Netw Open 2, e1918169
| Clinical Characteristics of and Risk Factors for Chronic Kidney Disease Among Adults and Children: An Analysis of the CURE-CKD Registry.Crossref | GoogleScholarGoogle Scholar |
Van Gelder VA, Scherpbier-De Haan ND, De Grauw WJC, Vervoort GMM, Van Weel C, Biermans MCJ, Braspenning JCC, Wetzels JFM (2016) Quality of chronic kidney disease management in primary care: a retrospective study. Scandinavian Journal of Primary Health Care 34, 73–80.
| Quality of chronic kidney disease management in primary care: a retrospective study.Crossref | GoogleScholarGoogle Scholar |
