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<h5 class="section-title" id="d6555928e200">Background</h5>
<p id="P1">Many individuals with chronic kidney disease (CKD) do not receive guideline-concordant
care. We examined the impact of a team-based primary care CKD registry on clinical
measures and processes of care among patients CKD cared for in a public safety-net
healthcare delivery system.
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<h5 class="section-title" id="d6555928e205">Study Design</h5>
<p id="P2">Pragmatic trial of a CKD registry versus a usual care registry for one
year</p>
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<h5 class="section-title" id="d6555928e210">Setting and Participants</h5>
<p id="P3">Primary care providers (PCPs) and their patients with CKD in safety-net
primary care
setting in San Francisco.
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<h5 class="section-title" id="d6555928e215">Intervention</h5>
<p id="P4">The CKD registry identified at point of care: all patients with CKD, those
with BP
>140/90 mmHg, those without ACEi/ARB prescription, and those without albuminuria
quantification
in the past year. It also provided quarterly feedback pertinent to these metrics to
promote CKD patient “outreach”. The usual care registry provided point-of-care cancer
screening and immunization data.
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<h5 class="section-title" id="d6555928e220">Outcomes</h5>
<p id="P5">Changes in systolic BP at 12 months (primary outcome), proportion of patients
with
BP control, prescription of ACEi/ARB, quantification of albuminuria, severity of albuminuria
and eGFR.
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<h5 class="section-title" id="d6555928e225">Results</h5>
<p id="P6">The patient population (n=746) had a mean age of 56.7 +/− 12.1 (SD) years,
was 53%
female and was diverse (8% non-Hispanic White, 35.7% Black, 24.5% Hispanic, 24.4%
Asian). Randomization to the CKD registry (30 PCPs, 285 patients) versus the usual
care registry (49 PCPs, 461 patients) was associated with a 2-fold greater odds of
ACEi/ARB prescription (adjusted OR, 2.25; 95%CI, 1.45-3.49) and albuminuria quantification
(adjusted OR, 2.44; 95% CI, 1.38-4.29) during the one-year study period. Randomization
to the CKD registry was not associated with changes in systolic BP, proportion of
patients with uncontrolled BP, or degree of albuminuria or eGFR.
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<h5 class="section-title" id="d6555928e230">Limitations</h5>
<p id="P7">Potential misclassification of CKD; missing baseline medication data; limited
to study
of a public safety-net healthcare system
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<h5 class="section-title" id="d6555928e235">Conclusion</h5>
<p id="P8">A team-based safety-net primary care CKD registry did not improve BP parameters,
but
led to greater albuminuria quantification and more ACEi/ARB prescriptions after one
year. Adoption of team-based CKD registries may represent an important step in translating
evidence into practice for CKD management.
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