Missed Opportunities for Early Chronic Kidney Disease Detection Among Adults with Coexisting Diabetes andHypertension in Primary Care

Abstract

Chronic kidney disease is a prevalent but mostly asymptomatic complication of diabetes and hypertension in the early stages. As such, its diagnosis is solely dependent on annual blood tests conducted by general practitioners who handle most adults suffering from these two diseases. However, there is still evidence showing that despite guideline-based recommendations that eGFR and UACR be measured annually for all patients, many of those who qualify are never even tested once in their life. This is an opportunity lost since the beginning of renal protection is delayed when it counts most. The purpose of the current investigation is to locate the places at which such missed opportunities occur during the care pathway of patients having diabetes mellitus and hypertension. Emphasis has been made on the completeness of testing, the recognition of abnormal findings, coding and staging of diagnoses, and delivery of preventive care. It has been highlighted that early diagnosis is not an independent activity, but a sequence of interrelated activities, and failure in any one step can defeat the entire purpose. This study considers the pathway as a series of interrelated cycles with identified points of loss, and associates each of the points of loss with a practical solution to address the problem at the systems level.