| Chronic kidney disease (CKD) has been recognized as an emerging public health problem with an estimated 13% of adults affected, resulting in an estimated 26.3 million adults in the United States in the year 2000. Many preventive measures along with evidence-based treatments have been shown to be effective at slowing the progression of kidney disease and reducing adverse events, the majority of which are cardiovascular in nature. The National Kidney Foundation, through the Kidney Disease Outcomes Quality Initiative (KDOQI), has released a series of clinical practice guidelines with recommendations for detection, monitoring, staging, and care of the chronic kidney disease population. Given the increased risk of cardiovascular morbidity and mortality in the chronic kidney disease population, it is essential to identify chronic kidney disease early and implement preventive therapies in patients with a known history of cardiovascular disease. The goals of this body of work are (1) to assess the sensitivity of national CKD prevalence estimates to varying methods of estimating glomerular filtration rate, varying quantifications of micro- and macroalbuminuria, and varying inclusion and exclusion criteria in the population being studied; (2) to assess utilization of preventive healthcare measures among patients with known CKD, stratified by comorbid cardiovascular disease status with a focus on primary and secondary prevention of cardiovascular complications; and (3) to assess the association of preventive healthcare utilization with subsequent complication rates, specifically addressing prevention of atherosclerotic heart disease events and death, major threats facing the CKD population. The analyses make use of both NHANES data and data from the general Medicare population to address utilization of specific preventive care recommendations made by the KDOQI clinical practice guidelines, including serum creatinine monitoring, control of hypertension, dyslipidemias, and calcium-phosphorus and parathyroid hormone imbalances, influenza vaccinations, diabetic A1c monitoring, and nephrology referral. Many areas are highlighted where improvements can be made with regards to monitoring of patients with chronic kidney disease, particularly among patients with a known history of cardiovascular disease. In addition to direct effects of treatment on cardiovascular event rates and death, early identification and treatment can slow disease progression thereby preventing or delaying morbidity and mortality. |
