CKD program. Education and research project conducted by PTMR

In Poland, chronic kidney disease (CKD) can affect up to 4 million people, but there is no data on this subject. The Polish Society of Family Medicine (PTMR) and the Polish Society of Nephrology conducted an epidemiological study on the prevalence of CKD in the population of high-risk patients. They invite doctors and health care providers to perform it.

Authors: Alicja Jazienicka-Kiełb, Mateusz Babicki, Magdalena Krajewska, Andrzej Oko, Agnieszka Mastalerz-Migas

Introduction
Chronic kidney disease (CKD) is a serious social problem due to its prevalence in the general population. Currently there is no data on the prevalence of this disease in Poland, and far too many patients are still undiagnosed. It is estimated that CKD [1]† Currently, the diagnosis is often only made in the decreasing phase of the disease, when renal replacement therapy remains the only therapeutic option. [2, 3]† Early detection of CKD and implementation of appropriate pharmacological and non-pharmacological treatment significantly improves the prognosis, therefore it is necessary to increase the detection of the disease in the initial stage. The diagnostic vigilance of general practitioners plays a major role in this, because they can pick up the disease at an early stage, influence the risk factors well and guide further treatment of the patient. [1, 4]†

Therefore, the Polish Society of General Practice and the Polish Society of Nephrology launched an epidemiological study on the prevalence of CKD in the population of high-risk patients. The project also includes an educational part (course) for general practitioners. For the purposes of the program, a special website www.pchn.edu.pl has been created.

Project Goals
The main aim of the project is to assess the prevalence of CKD among high-risk patients and to increase the awareness and knowledge of general practitioners in the diagnosis and treatment of CKD.

The following was planned for this:
• educational activities – an online course available to all doctors,
• CKD epidemiological research,
• developing a standard of care for a patient with CKD within primary health care.

Methodology
CKD knowledge research
As part of the project, a questionnaire survey among general practitioners on the level of knowledge about CKD was planned before the start of the training. The questionnaire was distributed via social media (Facebook) in closed medical groups and by sending invitations to complete it to members of the Polish Society of Family Medicine from the mailing database.

Educational course CKD for general practitioners
The next phase of the project is the implementation of an online course on kidney disease, in particular CKD. Issues raised included topics related to the identification of CKD risk factors, the indicated screening tests and their frequency, potential complications, and management of CKD. In addition – the most important information about acute renal failure and renal replacement therapy. Thanks to collaboration with experts in the field of nephrology, the proposed model of care for a patient with CKD was also presented. The issues are presented in a practical perspective to help as much as possible in daily clinical practice. The course is free and available to all physicians who wish to expand their knowledge in this area. Access to training materials and recordings is possible through the website of the Polish Society of Family Medicine (www.ptmr.info.pl) and directly on the project website (www.pchn.edu.pl). The framework program of the course is shown in Table 1.

Epidemiological research
The main phase of the project is to conduct a retrospective-prospective epidemiological study based on the analysis of anonymous data entered into a special database by GPs participating in the program. This information is anonymized in the healthcare facility by the physician entering it into the system, therefore the Polish Society of Family Medicine will not collect patient personal data or other data that would allow identification. Identification is only possible by the physician entering the patient into the database, after decoding the data in the healthcare facility to which the patient belongs.

As part of the project, an analysis of the medical records of several thousand patients at high risk of developing CKD was planned. The information collected relates to the results of laboratory studies commissioned by general practitioners, the socio-demographic characteristics of the patient (age, gender, place of residence, height, weight) and his medical history, including chronic diseases and medicines taken.

According to the established criteria, the program includes:
• people aged 60-75 or
• young people who meet at least one of the following conditions:
» obesity,
» History of kidney disease (other than CKD),
” hypertension,
” diabetes mellitus,
» Previous myocardial infarction,
» Chronic coronary syndrome (stable angina),
“Unstable angina,
»A history of stroke,
»A history of revascularization of the coronary arteries, lower extremity arteries, renal arteries, cerebral arteries, intracerebral arteries, or aorta,
» Heart failure in NYHA Class II – IV.

The exclusion criteria for participating in the study include:
• age younger than 18 years and older than 75 years,
• diagnosed chronic kidney disease.

The patient’s treatment will not go beyond the general practitioner’s standard of care for patients in risk groups (assessment of clinical status, control tests). In addition, the urine albumin-creatinine ratio (UACR) must be determined in the program. Due to the rigid diagnostic criteria of CKD, a procedure was suggested depending on the results of the patient’s laboratory tests.

Patient data entered into the database in the first stage should include:
• serum creatinine concentration and estimated glomerular filtration rate (eGFR),
• UACR value.

In the second phase, the data should only be entered into the database of those patients who required an in-depth assessment over a period of 3-6 months (according to the principles of CKD diagnosis):
• with eGFR • with UACR > 30 mg/g, regardless of the eGFR result in the first test.

The exact procedure algorithm is shown in Figure 1.

At any stage, if values ​​​​significantly deviated from the norm are detected, consultation with a nephrologist or implementation of appropriate medical procedures is recommended.

The obtained results will be used to determine the prevalence of CKD in the population of high-risk patients. The educational part of the project aims at acquiring knowledge and skills for diagnosing CKD in patients by general practitioners. The data obtained will also be useful in developing a standard of care for a patient with CKD in primary care.

Project executors
We invite physicians and healthcare providers interested in participating in the study and increasing their knowledge of CKD to conduct the project. Compensation is provided for the tasks associated with participation in the project. If you are interested, please contact: archiwum@pchn.edu.pl.

Literature
1. Król E, Rutkowski B. Chronic renal disease – classification, epidemiology and diagnosis. Forum Nefrol 2008; 1:1-6.
2. Coordinated care for a patient with chronic kidney disease. Gellert R (ed.). Nephron, Warsaw 2018.
3. Renke M, Parszuto J, Rybacki M et al. Chronic kidney disease – the relevant information for an occupational physician. Med Pr 2018; 69: 67-75.
4. Fraser Ds S, Blakeman T. Chronic kidney disease: identification and management in primary care. Pragmat Obs Res 2016; 7:21-32.

Full text of the article: Alicja Jazienicka-Kiełb, Mateusz Babicki, Magdalena Krajewska, Andrzej Oko, Agnieszka Mastalerz-Migas. Chronic kidney disease program. Education and research project conducted by the Polish Association of General Practice. POZ doctor 2022; 8(2): 112-115.

Leave a Comment