{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:39:49Z","timestamp":1786372789152,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2017,5]]},"abstract":"\n Background and objectives<\/jats:title>\n Awareness of CKD remains low in comparison with other chronic diseases, such as diabetes, leading to low use of preventive medications and appropriate testing. The objective of this study was to evaluate the quality of care provided to people with and at risk of CKD.<\/jats:p>\n <\/jats:sec>\n \n Design, setting, participants, & measurements<\/jats:title>\n \n We conducted a population-based analysis of all Albertans with eGFR=15\u201359 ml\/min per 1.73 m\n 2<\/jats:sup>\n between April 1, 2011 and March 31, 2012 as well as patients with diabetes (as of March 31, 2012). We assessed multiple quality indicators in people with eGFR=15\u201359 ml\/min per 1.73 m\n 2<\/jats:sup>\n , including appropriate risk stratification with albuminuria testing and preventive medication use and screened people with diabetes using urine albumin-to-creatinine ratio and serum creatinine measurements.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 96,480 adults with eGFR=15\u201359 ml\/min per 1.73 m\n 2<\/jats:sup>\n , we found that 17.0% of those without diabetes were appropriately risk stratified with a measure of albuminuria compared with 64.2% of those with diabetes (\n P<\/jats:italic>\n <0.001). Of those with eGFR=15\u201359 ml\/min per 1.73 m\n 2<\/jats:sup>\n and moderate or severe albuminuria, 63.2% of those without diabetes received an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker compared with 82.1% in those with diabetes (\n P<\/jats:italic>\n <0.001). Statin use was also significantly lower in patients with eGFR=15\u201359 ml\/min per 1.73 m\n 2<\/jats:sup>\n without diabetes (39.2%) compared with those with diabetes (64.6%;\n P<\/jats:italic>\n <0.001). Among 235,649 adults with diabetes, only 41.8% received a urine albumin-to-creatinine ratio and 73.2% received a serum creatinine measurement over 1 year.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n We identified large gaps in care, especially in those with CKD but no diabetes. The largest gap was in the prescription of guideline-concordant medication in those with CKD as well as appropriate screening for albuminuria in those with diabetes. Our work illustrates the importance of measuring health system performance as the first step in a quality improvement process to improve care and outcomes in CKD.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.08720816","type":"journal-article","created":{"date-parts":[[2017,4,4]],"date-time":"2017-04-04T20:26:46Z","timestamp":1491337606000},"page":"727-733","source":"Crossref","is-referenced-by-count":39,"title":["A Population-Based Analysis of Quality Indicators in CKD"],"prefix":"10.2215","volume":"12","author":[{"given":"Liam","family":"Manns","sequence":"first","affiliation":[{"name":"Interdisciplinary Chronic Disease Collaboration, Alberta, Canada;Departments of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nairne","family":"Scott-Douglas","sequence":"additional","affiliation":[{"name":"Interdisciplinary Chronic Disease Collaboration, Alberta, Canada;Departments of"},{"name":"Medicine and"},{"name":"Libin Cardiovascular Institute, and"},{"name":"O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; and"},{"name":"Alberta Health Services Kidney Health Strategic Clinical Network, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello","family":"Tonelli","sequence":"additional","affiliation":[{"name":"Interdisciplinary Chronic Disease Collaboration, Alberta, Canada;Departments of"},{"name":"Medicine and"},{"name":"Community Health Sciences,"},{"name":"Libin Cardiovascular Institute, and"},{"name":"O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Weaver","sequence":"additional","affiliation":[{"name":"Interdisciplinary Chronic Disease Collaboration, Alberta, Canada;Departments of"},{"name":"Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Tam-Tham","sequence":"additional","affiliation":[{"name":"Interdisciplinary Chronic Disease Collaboration, Alberta, Canada;Departments of"},{"name":"Community Health Sciences,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christy","family":"Chong","sequence":"additional","affiliation":[{"name":"Interdisciplinary Chronic Disease Collaboration, Alberta, Canada;Departments of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Hemmelgarn","sequence":"additional","affiliation":[{"name":"Interdisciplinary Chronic Disease Collaboration, Alberta, Canada;Departments of"},{"name":"Medicine and"},{"name":"Community Health Sciences,"},{"name":"Libin Cardiovascular Institute, and"},{"name":"O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2017,4,4]]},"reference":[{"key":"B1-20230813","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/S0140-6736(15)60692-4","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.","volume":"386","year":"2015","journal-title":"Lancet"},{"key":"B2-20230813","doi-asserted-by":"crossref","first-page":"E417","DOI":"10.1503\/cmaj.120833","article-title":"Prevalence estimates of chronic kidney disease in Canada: results of a nationally representative survey.","volume":"185","author":"Arora","year":"2013","journal-title":"CMAJ"},{"key":"B3-20230813","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/1471-2369-15-64","article-title":"Primary care physicians\u2019 familiarity, 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effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis.","volume":"326","author":"Law","year":"2003","journal-title":"BMJ"},{"key":"B8-20230813","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1093\/ndt\/gfn082","article-title":"A health economic analysis of screening and optimal treatment of nephropathy in patients with type 2 diabetes and hypertension in the USA.","volume":"23","author":"Palmer","year":"2008","journal-title":"Nephrol Dial Transplant"},{"key":"B9-20230813","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/1471-2369-10-30","article-title":"Overview of the alberta kidney disease network.","volume":"10","author":"Hemmelgarn","year":"2009","journal-title":"BMC Nephrol"},{"key":"B10-20230813","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate.","volume":"150","author":"Levey","year":"2009","journal-title":"Ann Intern Med"},{"key":"B11-20230813","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.","volume":"43","author":"Quan","year":"2005","journal-title":"Med Care"},{"key":"B13-20230813","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1161\/HYPERTENSIONAHA.109.139279","article-title":"Validation of a case definition to define hypertension using administrative data.","volume":"54","author":"Quan","year":"2009","journal-title":"Hypertension"},{"key":"B14-20230813","article-title":"Development of quality indicators for care of chronic kidney disease in the primary care setting using electronic health data: A RAND-modified Delphi method [published online ahead of print May 4, 2016].","author":"Fukuma","journal-title":"Clin Exp Nephrol"},{"key":"B15-20230813","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1097\/MAJ.0000000000000475","article-title":"Underprescription of renin-angiotensin system blockers in moderate to severe chronic kidney disease.","volume":"349","author":"Shirazian","year":"2015","journal-title":"Am J Med Sci"},{"key":"B16-20230813","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1038\/ki.2015.246","article-title":"Implementation of the KDIGO guideline on lipid management requires a substantial increase in statin prescription rates.","volume":"88","author":"Schneider","year":"2015","journal-title":"Kidney Int"},{"key":"B17-20230813","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.diabet.2012.08.004","article-title":"Prevalence, screening and treatment of chronic kidney disease in people with type 2 diabetes in France: the ENTRED surveys (2001 and 2007).","volume":"38","author":"Assogba","year":"2012","journal-title":"Diabetes Metab"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01277230-201705000-00005","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:36:39Z","timestamp":1786368999000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01277230-201705000-00005"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,4,4]]},"references-count":15,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.08720816","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,4,4]]}}}