Abstract for presentation at Australia and New Zealand Society of Nephrology Annual Scientific Conference

Objective: To examine the factors that influence the identification of CKD in the Australian primary care setting in patients with type 2 diabetes.
Design, setting and participants: 348 GP investigators were asked to estimate kidney function and its severity in 10-15 consecutively presenting adult patients with established type 2 diabetes. Estimates of kidney function were systematically compared to estimates of kidney function made by GPs themselves and their classification of kidney function on an individual patient basis.
Results: 2.4% of patients had their kidney function routinely estimated by their local laboratory, and 24.0% had their kidney function routinely estimated by their GP. Few of these patients had impaired kidney function or risks for CKD. There was a good correlation between practitioner-estimated values and those derived using the Cockroft-Gault equation (R2=0.72). GPs identified individuals with data-derived estimates below 60 ml/min in over 83% of cases, with a specificity of 90%. Impaired kidney function was reported by practitioners to be present in 34.4% of men and 36.4% of women. This figure was discordant with kidney function derived using the Cockroft-Gault formula, as well as the level of kidney function estimated by the GPs themselves, with an overlap in only half of all individuals. Raw serum creatinine levels continue to influence the perception of CKD, over-and-above estimated of kidney function.
Conclusion: Without automatic reporting, GPs are currently able to accurately assess kidney function. However, the implications of kidney function to the assessment and management of patients with type 2 diabetes are seldom identified.