A Cluster Randomized Trial of an Enhanced eGFR Prompt in Chronic Kidney Disease

作者：Manns Braden^*; Tonelli Marcello; Culleton Bruce; Faris Peter; McLaughlin Kevin; Chin Rick; Gooch Katherine; McAlister Finlay A; Taub Ken; Thorlacius Laurel; Krause Richard; Kearns Monica; Hemmelgarn Brenda

来源：Clinical Journal of the American Society of Nephrology, 2012, 7(4): 565-572.

DOI：10.2215/CJN.12391211

Background and objectives Despite reporting estimated GFR (eGFR), use of evidence-based interventions in CKD remains suboptimal. This study sought to determine the effect of an enhanced eGFR laboratory prompt containing specific management recommendations, compared with standard eGFR reporting in CKD. %26lt;br%26gt;Design, setting, participants, %26 measurements A cluster randomized trial of a standard or enhanced eGFR laboratory prompt was performed in 93 primary care practices in Alberta, Canada. Although all adult patients with CKD (eGFR %26lt;60 ml/min per 1.73 m(2)) were included, medication data were only available for elderly patients (aged %26gt;= 66 years). The primary outcome, the proportion of patients with diabetes or proteinuria receiving an angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB), was assessed in elderly CKD patients. %26lt;br%26gt;Results There were 5444 elderly CKD patients with diabetes or proteinuria who were eligible for primary outcome assessment, irrespective of baseline ACEi/ARB use. ACEi/ARB use in the subsequent year was 77.1% and 76.9% in the standard and enhanced prompt groups, respectively. In the subgroup of elderly patients with an eGFR %26lt;30 ml/min per 1.73 m(2), ACEi/ARB use was higher in the enhanced prompt group. Among 22,092 CKD patients, there was no difference in the likelihood of a composite clinical outcome (death, ESRD, doubling of serum creatinine, or hospitalization for myocardial infarction, heart failure, or stroke) over a median of 2.1 years. %26lt;br%26gt;Conclusions In elderly patients with CKD and an indication for ACEi/ARB, an enhanced laboratory prompt did not increase use of these medications. Clin J Am Soc Nephrol 7: 565-572, 2012. doi: 10.2215/CJN.12391211

• 出版日期2012-4