A nationwide US study has uncovered major gaps in quality, guideline-oriented care forchronic kidney disease(CKD), as detailed in a new studypublished onlineJuly 11 in theClinical Journal of the American Society ofNephrology.

The results reveal that care among individuals with CKD has not improved over 10 years.

"CKD, where kidney function is reduced or the kidney shows signs of damage, is a major public health problem. Controlling risk factors, such as high blood pressure and diabetes, and using evidence-based medications in patients with CKD is especially critical to decrease the risk of kidney failure," lead author Sri Lekha Tummalapalli, MD, MBA, University of California, San Francisco, said in a press release by the American Society of Nephrology.

Specifically, rates ofuncontrolled hypertensionstayed the same over the decade studied, and rates of uncontrolled diabetes were high. And use of angiotensin-converting enzyme (ACE) inhibitors/angiotensin-receptor blockers (ARBs) — which studies have shown may decrease progression to end-stage renal disease (ESRD) — actually decreased.

Meanwhile, guideline-recommended statins are substantially underused among individuals with CKD. But use of nonsteroidal anti-inflammatory drugs (NSAIDs), which the American Board of Medicine recommends should be avoided in CKD, has increased slightly.

The findings highlight "a more urgent need for CKD-specific quality measures and implementation of quality improvement interventions," the researchers stress.

National Conversation About CKD

About 30 million Americans suffer from CKD, according to background information in the new article. Improving care for these people has the potential to improve health and delay progression to kidney failure.

"There is a national conversation happening right now about kidney disease. National professional organizations, government, and insurance are coalescing to improve care models for kidney disease," Tummalapalli noted.

Indeed, earlier this week, the Trump administration signed an executive order for changing the Medicare payment for ESRD, with a focus on increasing kidney donation and home dialysis,as reportedbyMedscape Medical News.

"Preventing kidney failure and decreasing the risk of other complications, such as heart disease, starts at early stages of CKD. Our research highlights the current gaps in care," Tummalapalli stressed.

Past studies have suggested poor quality of care for patients with CKD, but few have looked at nationwide trends for the issue, say Tummalapalli and coauthors.

So they conducted their nationwide cross-sectional study using data from the National Ambulatory Medical Care Survey (NAMCS), a sampling of office-based care in the United States. The analysis included office visits for adults with CKD from 2006-2014