Identification and prereferral care for patients with chronic kidney disease by Nigerian family medicine trainee

Abstract

Background: The family physician is usually the first contact between patients and the health care system at the tertiary level, and they play an important role in the screening for chronic kidney disease (CKD), treatment of reversible causes, and timely referral to the nephrologist. We do not know if the future family physician in Nigeria is prepared for this important role, prompting us to carry out this study. Materials and Methods: Self-administered questionnaires were given to family medicine trainees attending a nationally organized revision course. Results: Two hundred questionnaires were distributed and 172 were returned Guidelines for the management of CKD were correctly identified by only 18% of the participants. The screening methods that were identified for CKD included urinalysis (43.6%), serum creatinine alone (72.7%), estimation of glomerular filtration rate (70.3%), and renal ultrasound (30.5%). Less than 50% were aware of the recommended frequency of screening for diabetic and elderly patients while less than 25% were aware of coronary artery disease and stroke as complications of CKD. After a diagnosis of CKD, 40.4% would refer immediately to the nephrologist, while 33%, 13%, and 2% would use the serum creatinine level alone, estimated glomerular filtration rate (GFR), and clinical features, respectively, as guides in taking decisions on referral. Conclusion: A good number of the participants had poor knowledge in the aspects of identification of patients with CKD, initial evaluation of such patients and eventual referral to nephrologists. Concerted efforts are needed to improve this knowledge in the family physician trainees of Nigeria.