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Abstract #158268

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Jeffrey Cohen, MD¹, Sheikh Jasimuddin, MD², Barbara C. Tommasulo, MD, CMD, LNHA², Yosef Dlugacz, PhD³, Charles Cal, RN, MS, MBA⁴, Roshan Hussain, MPH³, Edan Shapiro⁵, Avi Singavaparu⁵, Joshua Vernatter⁵, and Gisele Wolf-Klein, MD¹. (1) Geriatrics, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040, (516) 570-2599, jeffcohen169@hotmail.com, (2) Cold Spring Hills Center for Nursing & Rehabilitation, 378 Syosset-Woodbury Road, Woodbury, NY 11797, (3) Krasnoff Quality Management Institute, 600 Northern Blvd, Suite 220B, Great Neck, NY 11021, (4) Suite 220B, 600 Northern Blvd, 600 Northern Blvd, Suite 220B, Great Neck, NY 11021, (5) Albert Einstein College of Medicine of Yeshiva University, 1300 Morris Park Avenue, Bronx, NY 10461

Objective: Early diagnosis of chronic kidney disease (CKD) in the elderly allows for the implementation of measures proven to delay progression to dependence on dialysis, reduce risk for cardiac complications, and improve medication management. Given that the National Kidney Foundation (NKF) published stage-based protocols (2002) to delay/prevent outcomes associated with CKD, it is incumbent upon physicians to recognize CKD. The purpose of this study is to explore how frequently elderly nursing home residents who qualify for the diagnosis of CKD using NKF criteria are actually recognized by their physicians as having CKD.

Methods: A retrospective chart review was performed on all long-term elderly residents within a 672-bed facility who had resided there for at least 6 months and whose records included at least two serum creatinine levels drawn at least 90 days apart from each other. Each subject's monthly internist progress notes were reviewed to determine if the subject had received a clinical diagnosis of CKD. Glomerular filtration rates (GFRs) were calculated via the Modified Diet in Renal Disease (MDRD) and Cockgraft-Gault formulas.

Results: 280 subjects cared for by 30 internists were studied. The majority (70%) were women; average patient age was 83.1 years. Of the 71 subjects who had CKD by MDRD criteria, 62.0% had not been diagnosed by their physicians. Of subjects with CKD by Cockgraft-Gault criteria, 82.0% had not been formally diagnosed.

Conclusion: Despite well-established criteria for the diagnosis, CKD remains exceedingly underdetected within the nursing home, placing this community at increased risk for costly, avoidable outcomes.

Learning Objectives:

• 1.Recognize that age is one of the five major risk factors for chronic kidney disease (CKD).
• 2.Learn criteria for diagnosis of CKD.
• 3.Appreciate that CKD is underdiagnosed within the nursing home population.
• 4.Understand that CKD places one at risk for adverse outcomes including dialysis dependence, cardiac disease, and medication toxicity.
• 5.Articulate reasons for underutilization of current standards for diagnosis of CKD within the nursing home.

Keywords: Nursing Homes, Quality Improvement

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

• Slides (pdf) or Handout
• Multimedia recording