Awareness and Knowledge of Clinical Practice Guidelines for CKD Among Internal Medicine Residents: A National Online Survey

Background: The National Kidney Foundation published Kidney Disease Outcomes Quality Initiative guidelines that recommend early detection and management of chronic kidney disease (CKD) and timely referral to a nephrologist. Many patients with CKD are seen by primary care physicians who are less experienced than nephrologists to offer optimal pre-end-stage renal disease care. It is not known whether current postgraduate training adequately prepares a future internist in CKD management. Study Design: Cross-sectional study using an online questionnaire survey. Setting & Participants: Internal medicine residents in the United States (n = 479) with postgraduate year (PGY) distribution of 166 PGY1, 187 PGY2, and 126 PGY3. Predictor: Awareness and knowledge of CKD clinical practice guidelines measured by using the questionnaire instrument. Outcomes & Measurements: Total performance score (maximum = 30). Results: Half the residents did not know that the presence of kidney damage (proteinuria) for 3 or more months defines CKD. One-third of the residents did not know the staging of CKD. All residents (99%) knew the traditional risk factors for CKD of diabetes and hypertension, but were less aware of other risk factors of obesity (38%), elderly age (71%), and African American race (68%). Most residents (87%) were aware of estimated glomerular filtration rate in the evaluation of patients with CKD. Most residents (90%) knew goal blood pressure (< 130/80 mm Hg) for patients with CKD. Most residents identified anemia (91%) and bone disorder (82%) as complications of CKD, but only half recognized CKD as a risk factor for cardiovascular disease. Most residents (90%) chose to refer a patient with a glomerular filtration rate less than 30 mL/min/1.73 m(2) to a nephrologist. A small improvement in mean performance score was observed with increasing PGY (PGY1, 68.8% +/- 15.4%; PGY2, 72.9% +/- 14.7%; and PGY3, 74.0% +/- 12.0%; P = 0.004). Limitations: Self-selection, lack of nonrespondent data. Conclusions: Our survey identified specific gaps in knowledge of CKD guidelines in internal medicine residents. Educational efforts in increasing awareness of these guidelines may improve CKD management and clinical outcomes.