Reporting of estimated glomerular filtration rate: Effect on physician recognition of chronic kidney disease and prescribing practices for elderly hospitalized patients

BACKGROUND: Physician recognition of chronic kidney disease (CKD) in elderly patients has been noted to be poor. These patients are at increased risk of medication dosing errors and acute renal failure. OBJECTIVE: To investigate the effect of reporting estimated glomerular filtration rate (GFR) of elderly hospitalized patients on physician recognition of CKD and physician prescribing behaviors. DESIGN: A retrospective combined with a prospective medical record review project. SETTING: A large academic medical center. PATIENTS: Patients included were 65 years of age or older and had creatinine values within the normal laboratory range (< 1.6 mg/dL). INTERVENTION: Reporting a calculated estimate of GFR to physicians. MEASUREMENTS: Rates of recognition of CKD were examined before and after the intervention. The effects of the intervention on prescription of renal-dosed antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDS) and cyclooxygenase-2 inhibitors (COX-2) at hospital discharge were assessed. RESULTS: A total of 260 and 198 patients were included before and after the intervention, respectively. Recognition of chronic kidney disease was low in both groups but demonstrated a significant increase following reporting of estimated GFR (3.9% to 12.6%, P <.001). Reporting of GFR was not associated with a significant decrease in prescription of NSAID/COX-2 medications or increased rates of correct dosing of antibiotics (P = .10 and P = .81, respectively). CONCLUSIONS: Although reporting of estimated GFR was associated with improved physician recognition of CKD in elderly hospitalized patients, it did not lead to a change in physician prescribing. More extensive interventions are necessary to increase recognition and decrease medication dosing errors. Journal of Hospital Medicine 2007;2:74-78. (c) 2007 Society of Hospital Medicine.