Physicians’ Recognition and Management of Kidney Disease: A Randomized Vignette Study Evaluating the Impact of the KDIGO 2012 CKD Classification System

Abstract Rationale and Objective KDOQI and KDIGO CKD classification systems published in 2002 and 2012, respectively, are recommended world-wide and based on strong epidemiological data. However, their impact on CKD recognition and management is not well evaluated in clinical practice, and we therefore investigated whether they help physicians recognize and appropriately care for CKD patients. Study Design Randomized vignette experiment with fractional factorial design based on 6 kidney-related scenarios and 3 laboratory presentation methods reflecting the CKD guidelines. Participants evaluated one of three subsets of the 18 vignettes (i.e. 6 vignettes each with 4 answer alternatives). Setting and Participants 249 interns, general practitioners, and residents/fellows attending post-graduate meetings and courses in Norway and the US. Intervention Kidney related results (serum creatinine and urine albumin) were presented as the "minimal data" (high/low levels), "KDOQI-2002" (eGFR reported automatically), or "KDIGO-2012" (eGFR + albuminuria categorization + risk for complications) laboratory report. Outcome CKD management choice by physicians. Results When kidney laboratory data were presented as the "KDOQI-2002" report (automatic eGFR calculation), there was a significantly higher odds for correct patient management decisions, compared to the "minimal data" report (OR 1.57, p Limitations Physicians` management was evaluated by theoretical scenarios rather than direct patient care. Conclusion Automatic GFR estimation, albuminuria categorization, and notification of the associated risk for complications improve most physicians` recognition and management of a wide range of CKD clinical scenarios.