Quality of chronic kidney disease care in Canada: room for improvement

Background: Chronic Kidney Disease (CKD) can be associated with many poor outcomes. Studies are required to assess gaps in care and the potential for improvements. Research is needed to determine the optimal process of care for CKD. -- Methods: 1) A multi-centre Canadian prospective survey examined patient's clinical status as they initiated dialysis. 2) A case-control study of incident dialysis patients evaluated clinical outcomes of patients previously exposed to formalized multidisciplinary clinic programs versus standard nephrology care. 3) A prospective multicentre Canadian cohort study of patients initially referred to nephrology with measured or estimated glomerular filtration rate less than 50 mL/min/1.73m² evaluated patient status at referral, and nephrology intervention at first encounter. -- Results: 1) Canadian patients commencing dialysis in 1998-1999 appeared to be doing so in relative concordance with published guidelines with respect to timing of initiation. Despite an increased awareness of kidney disease, a substantial number of patients continued to commence dialysis without previous care by a nephrologist. Of those who were seen by nephrologists, clinical and laboratory parameters are suboptimal according to current guidelines. 2) Despite equal and long exposure to nephrology care prior to dialysis, there appeared to be an association of survival advantage for those patients exposed to formalized clinic care in addition to standard nephrologist follow-up. 3) CKD patients continued to have their first encounter with a nephrologist late in their disease course. Information on prior evaluation was incompletely transmitted to the nephrologist. There appears to be room for improvement in evaluation and treatment at the first nephrology encounter. -- Conclusions: CKD care appears to be sub-optimal. Multidisciplinary clinics may play a role in improving outcomes. Further research is needed to address this care model