Early detection and treatment of renal disease in hospitalized diabetic and hypertensive patients: Important differences between practice and published guidelines
This study was performed to ascertain the degree to which the care of hospitalized diabetic and hypertensive patients conforms to published guidelines for the detection and management of early renal disease. It was designed as a retrospective chart audit. Six hospitals, four nonurban referral center...
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Veröffentlicht in: | American journal of kidney diseases 1997-03, Vol.29 (3), p.368-375 |
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description | This study was performed to ascertain the degree to which the care of hospitalized diabetic and hypertensive patients conforms to published guidelines for the detection and management of early renal disease. It was designed as a retrospective chart audit. Six hospitals, four nonurban referral centers, and two urban teaching institutions provided the data. Patients were a random sample of Medicare beneficiaries, with a mean age (SD) of 65.6 (9.1) years, admitted during 1994 with a primary or secondary diagnosis of either diabetes (n = 260) or hypertension (n = 327). A urinalysis was obtained for 163 (62.7%) of the diabetic patients. Among diabetics who had their urine tested, 31.3% had 1 + or greater dipstick proteinuria. A serum creatinine was obtained for 298 (91%) of the hypertensive patients, and 11.8% had a value of 1.5 mg/dL or greater. Abnormal renal function tests were recorded in the discharge summaries of 7.8% of the diabetic and 11.4% of the hypertensive patients. Patients with abnormal renal function were no more likely to be treated with angiotensin-converting enzyme inhibitors (ACEIs). Nonsteroidal antiinflammatory drugs (NSAIDs) were prescribed for 6% of diabetic and 8.8% of hypertensive patients with abnormal renal function at discharge. Despite the high prevalence of renal functional abnormalities detected by routine laboratory tests administered to elderly hospitalized diabetic and hypertensive patients, the medical records of these patients did not document awareness or appropriate management of the potential underlying kidney disease. |
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It was designed as a retrospective chart audit. Six hospitals, four nonurban referral centers, and two urban teaching institutions provided the data. Patients were a random sample of Medicare beneficiaries, with a mean age (SD) of 65.6 (9.1) years, admitted during 1994 with a primary or secondary diagnosis of either diabetes (n = 260) or hypertension (n = 327). A urinalysis was obtained for 163 (62.7%) of the diabetic patients. Among diabetics who had their urine tested, 31.3% had 1 + or greater dipstick proteinuria. A serum creatinine was obtained for 298 (91%) of the hypertensive patients, and 11.8% had a value of 1.5 mg/dL or greater. Abnormal renal function tests were recorded in the discharge summaries of 7.8% of the diabetic and 11.4% of the hypertensive patients. Patients with abnormal renal function were no more likely to be treated with angiotensin-converting enzyme inhibitors (ACEIs). Nonsteroidal antiinflammatory drugs (NSAIDs) were prescribed for 6% of diabetic and 8.8% of hypertensive patients with abnormal renal function at discharge. Despite the high prevalence of renal functional abnormalities detected by routine laboratory tests administered to elderly hospitalized diabetic and hypertensive patients, the medical records of these patients did not document awareness or appropriate management of the potential underlying kidney disease.</description><identifier>ISSN: 0272-6386</identifier><identifier>EISSN: 1523-6838</identifier><identifier>DOI: 10.1016/S0272-6386(97)90197-9</identifier><identifier>PMID: 9041212</identifier><language>eng</language><publisher>Orlando, FL: Elsevier Inc</publisher><subject>Aged ; Biological and medical sciences ; Diabetic Nephropathies - diagnosis ; Diabetic Nephropathies - therapy ; Female ; Georgia ; Hospitals - standards ; Humans ; Hypertension - diagnosis ; Hypertension - therapy ; Kidney Failure, Chronic - diagnosis ; Kidney Failure, Chronic - therapy ; Kidneys ; Male ; Medical Audit - statistics & numerical data ; Medical sciences ; Medicare - statistics & numerical data ; Middle Aged ; Nephrology. Urinary tract diseases ; Practice Guidelines as Topic ; Practice Patterns, Physicians ; Proteinuria - diagnosis ; Proteinuria - therapy ; Random Allocation ; Retrospective Studies ; Time Factors ; United States ; Urinary system involvement in other diseases. 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It was designed as a retrospective chart audit. Six hospitals, four nonurban referral centers, and two urban teaching institutions provided the data. Patients were a random sample of Medicare beneficiaries, with a mean age (SD) of 65.6 (9.1) years, admitted during 1994 with a primary or secondary diagnosis of either diabetes (n = 260) or hypertension (n = 327). A urinalysis was obtained for 163 (62.7%) of the diabetic patients. Among diabetics who had their urine tested, 31.3% had 1 + or greater dipstick proteinuria. A serum creatinine was obtained for 298 (91%) of the hypertensive patients, and 11.8% had a value of 1.5 mg/dL or greater. Abnormal renal function tests were recorded in the discharge summaries of 7.8% of the diabetic and 11.4% of the hypertensive patients. Patients with abnormal renal function were no more likely to be treated with angiotensin-converting enzyme inhibitors (ACEIs). Nonsteroidal antiinflammatory drugs (NSAIDs) were prescribed for 6% of diabetic and 8.8% of hypertensive patients with abnormal renal function at discharge. Despite the high prevalence of renal functional abnormalities detected by routine laboratory tests administered to elderly hospitalized diabetic and hypertensive patients, the medical records of these patients did not document awareness or appropriate management of the potential underlying kidney disease.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Diabetic Nephropathies - diagnosis</subject><subject>Diabetic Nephropathies - therapy</subject><subject>Female</subject><subject>Georgia</subject><subject>Hospitals - standards</subject><subject>Humans</subject><subject>Hypertension - diagnosis</subject><subject>Hypertension - therapy</subject><subject>Kidney Failure, Chronic - diagnosis</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Kidneys</subject><subject>Male</subject><subject>Medical Audit - statistics & numerical data</subject><subject>Medical sciences</subject><subject>Medicare - statistics & numerical data</subject><subject>Middle Aged</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Practice Guidelines as Topic</subject><subject>Practice Patterns, Physicians</subject><subject>Proteinuria - diagnosis</subject><subject>Proteinuria - therapy</subject><subject>Random Allocation</subject><subject>Retrospective Studies</subject><subject>Time Factors</subject><subject>United States</subject><subject>Urinary system involvement in other diseases. 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Urinary tract diseases</topic><topic>Practice Guidelines as Topic</topic><topic>Practice Patterns, Physicians</topic><topic>Proteinuria - diagnosis</topic><topic>Proteinuria - therapy</topic><topic>Random Allocation</topic><topic>Retrospective Studies</topic><topic>Time Factors</topic><topic>United States</topic><topic>Urinary system involvement in other diseases. Miscellaneous</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McClellan, William M.</creatorcontrib><creatorcontrib>Knight, Dawn F.</creatorcontrib><creatorcontrib>Karp, Herbert</creatorcontrib><creatorcontrib>Brown, Wendy W.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of kidney diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McClellan, William M.</au><au>Knight, Dawn F.</au><au>Karp, Herbert</au><au>Brown, Wendy W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early detection and treatment of renal disease in hospitalized diabetic and hypertensive patients: Important differences between practice and published guidelines</atitle><jtitle>American journal of kidney diseases</jtitle><addtitle>Am J Kidney Dis</addtitle><date>1997-03-01</date><risdate>1997</risdate><volume>29</volume><issue>3</issue><spage>368</spage><epage>375</epage><pages>368-375</pages><issn>0272-6386</issn><eissn>1523-6838</eissn><abstract>This study was performed to ascertain the degree to which the care of hospitalized diabetic and hypertensive patients conforms to published guidelines for the detection and management of early renal disease. It was designed as a retrospective chart audit. Six hospitals, four nonurban referral centers, and two urban teaching institutions provided the data. Patients were a random sample of Medicare beneficiaries, with a mean age (SD) of 65.6 (9.1) years, admitted during 1994 with a primary or secondary diagnosis of either diabetes (n = 260) or hypertension (n = 327). A urinalysis was obtained for 163 (62.7%) of the diabetic patients. Among diabetics who had their urine tested, 31.3% had 1 + or greater dipstick proteinuria. A serum creatinine was obtained for 298 (91%) of the hypertensive patients, and 11.8% had a value of 1.5 mg/dL or greater. Abnormal renal function tests were recorded in the discharge summaries of 7.8% of the diabetic and 11.4% of the hypertensive patients. Patients with abnormal renal function were no more likely to be treated with angiotensin-converting enzyme inhibitors (ACEIs). Nonsteroidal antiinflammatory drugs (NSAIDs) were prescribed for 6% of diabetic and 8.8% of hypertensive patients with abnormal renal function at discharge. Despite the high prevalence of renal functional abnormalities detected by routine laboratory tests administered to elderly hospitalized diabetic and hypertensive patients, the medical records of these patients did not document awareness or appropriate management of the potential underlying kidney disease.</abstract><cop>Orlando, FL</cop><pub>Elsevier Inc</pub><pmid>9041212</pmid><doi>10.1016/S0272-6386(97)90197-9</doi><tpages>8</tpages></addata></record> |
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subjects | Aged Biological and medical sciences Diabetic Nephropathies - diagnosis Diabetic Nephropathies - therapy Female Georgia Hospitals - standards Humans Hypertension - diagnosis Hypertension - therapy Kidney Failure, Chronic - diagnosis Kidney Failure, Chronic - therapy Kidneys Male Medical Audit - statistics & numerical data Medical sciences Medicare - statistics & numerical data Middle Aged Nephrology. Urinary tract diseases Practice Guidelines as Topic Practice Patterns, Physicians Proteinuria - diagnosis Proteinuria - therapy Random Allocation Retrospective Studies Time Factors United States Urinary system involvement in other diseases. Miscellaneous |
title | Early detection and treatment of renal disease in hospitalized diabetic and hypertensive patients: Important differences between practice and published guidelines |
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