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This cross-sectional descriptive study, conducted at the Departments of Nephrology, PGIMER, Chandigarh, aimed to evaluate the prevalence of low-value care among 500 Chronic Kidney Disease (CKD) patients over a 16-month period from August 2021 to November 2022.
Patients meeting inclusion criteria, irrespective of CKD stage, were enrolled after consent. CKD stages were done as per KDIGO guidelines 2012. Prescription analysis focussed hypertension, lipid management, anemia, mineral bone disease, acidosis, and vaccination practices.
In our study involving 500 Chronic Kidney Disease (CKD) patients, primarily men (72.6%) with a mean age of 41.9 years were included. Significant disparities were found in their management. Most patients were in advanced CKD stages, with 70.4% in stage G5 D. Alarmingly, 67.5% of prescriptions were from non-qualified nephrologists, potentially influencing the quality of care provided.
Across various management parameters, while 94.4% underwent standardized blood pressure checks, only 43.8% received guidance for home measurements, indicating a gap in comprehensive monitoring. Only 15% of patients underwent lipid profiles. Among those on hypolipidemic agents, 68.8% lacked essential lipid profile assessments. Limited assessments for iron profile (17%), vitamin B12 (9%), and folate (6.5%) were observed in addressing anemia among CKD patients. A concerning 60.5% received ESA without prior iron profiles, while 58% lacked B12/folate assays. Poor assessment of calcium, phosphorus, PTH, and vitamin D was evident. Supplementation was often given without corresponding assays. Only 9% had bicarbonate levels checked, yet 68.4% received oral bicarbonate supplementation. Rates of Hepatitis B (23%) and Pneumococcus (7%) vaccinations were notably low.
The study highlighted a prevalent use of low-value therapy across multiple parameters: hypertension (50%), lipids (85%), anemia (75%), MBD (80%), acidosis (90%), and vaccination (85%). Shockingly, 17% of patients received low-value therapy in all evaluated areas, while 47.4% had it in four out of five parameters, indicating a widespread issue.
Patient compliance was also a concern, with 36% non-compliance noted. Reasons varied from lack of awareness (36.11%) to seeking second opinions (22.22%).
The study unveils pervasive instances of low-value care across multiple CKD management facets. Deficiencies in adherence to KDIGO guidelines were evident, possibly influenced by non-specialist prescriptions (67.5%) and insufficient awareness among patients. These lapses in care may stem from healthcare access limitations, delayed referrals, and financial burdens. The findings highlight substantial gaps in CKD patient management, emphasizing the urgency for better education among general physicians and increased adherence to standardized guidelines. Addressing these deficiencies is critical to improve patient outcomes and mitigate the financial burden on CKD patients in developing countries including India.