Proteinuria among patients with chronic kidney disease: A performance measure for improving patient outcomes

Micah L. Thorp; David H. Smith; Eric S. Johnson; Suma Vupputuri; Jessica W. Weiss; Amanda F. Petrik; Xuihai Yang; Andrew S. Levey; Haimanot Wasse; Rosemary Muoneke; Susan R. Snyder

doi:10.1016/s1553-7250(12)38035-5

Proteinuria among patients with chronic kidney disease: A performance measure for improving patient outcomes

Micah L. Thorp, David H. Smith, Eric S. Johnson, Suma Vupputuri, Jessica W. Weiss, Amanda F. Petrik, Xuihai Yang, Andrew S. Levey, Haimanot Wasse, Rosemary Muoneke, Susan R. Snyder

Nephrology and Hypertension

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Background: In an effort to improve identification and treatment of patients with chronic kidney disease (CKD), the National Kidney Foundation (NKF) developed the Kidney Disease Quality Outcomes Initiative (KDQOI) clinical practice guidelines, which include measurement of proteinuria among all patients with CKD who are not receiving chronic dialysis therapy. Encouraging dissemination and utilization of these guidelines may be enhanced by the development of performance measures. The question of whether adequate evidence exists to advocate for the measurement of proteinuria in CKD as a performance measure was explored. Methods: The US Preventive Services Task Force "chain of evidence" framework was used to guide evidence synthesis from the systematic review. Five questions were applied to specific links in the evidence chain: (1) Is there direct evidence that testing for proteinuria improves health outcomes? (2) What is the yield of testing, in terms of both accuracy and reliability of the test and the prevalence of undiagnosed proteinuria? (3) What adverse effects result from testing a person for proteinuria? (4) Does treatment of proteinuria as a result of testing provide an incremental benefit in health outcomes? and (5) What adverse effects result from treating a person for proteinuria? The systematic search specifically targeted meta-analyses and systematic reviews. Findings: The systematic review revealed no direct evidence that testing for proteinuria among patients with CKD reduced incidence of end-stage renal disease (ESRD). However, the strong links between testing, treatment, and outcome suggest a correlation between proteinuria testing and ESRD. Conclusions: Current evidence suggests that proteinuria testing (using the albumin-to-creatinine ratio [ACR]) among patients with CKD would be an appropriate health care quality performance measure for improving patient outcomes. Copyright 2012

Original language	English (US)
Pages (from-to)	277-282
Number of pages	6
Journal	Joint Commission Journal on Quality and Patient Safety
Volume	38
Issue number	6
DOIs	https://doi.org/10.1016/s1553-7250(12)38035-5
State	Published - Jun 2012

ASJC Scopus subject areas

Leadership and Management

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Thorp, M. L., Smith, D. H., Johnson, E. S., Vupputuri, S., Weiss, J. W., Petrik, A. F., Yang, X., Levey, A. S., Wasse, H., Muoneke, R., & Snyder, S. R. (2012). Proteinuria among patients with chronic kidney disease: A performance measure for improving patient outcomes. Joint Commission Journal on Quality and Patient Safety, 38(6), 277-282. https://doi.org/10.1016/s1553-7250(12)38035-5

Thorp, ML, Smith, DH, Johnson, ES, Vupputuri, S, Weiss, JW, Petrik, AF, Yang, X, Levey, AS, Wasse, H, Muoneke, R & Snyder, SR 2012, 'Proteinuria among patients with chronic kidney disease: A performance measure for improving patient outcomes', Joint Commission Journal on Quality and Patient Safety, vol. 38, no. 6, pp. 277-282. https://doi.org/10.1016/s1553-7250(12)38035-5

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title = "Proteinuria among patients with chronic kidney disease: A performance measure for improving patient outcomes",

abstract = "Background: In an effort to improve identification and treatment of patients with chronic kidney disease (CKD), the National Kidney Foundation (NKF) developed the Kidney Disease Quality Outcomes Initiative (KDQOI) clinical practice guidelines, which include measurement of proteinuria among all patients with CKD who are not receiving chronic dialysis therapy. Encouraging dissemination and utilization of these guidelines may be enhanced by the development of performance measures. The question of whether adequate evidence exists to advocate for the measurement of proteinuria in CKD as a performance measure was explored. Methods: The US Preventive Services Task Force {"}chain of evidence{"} framework was used to guide evidence synthesis from the systematic review. Five questions were applied to specific links in the evidence chain: (1) Is there direct evidence that testing for proteinuria improves health outcomes? (2) What is the yield of testing, in terms of both accuracy and reliability of the test and the prevalence of undiagnosed proteinuria? (3) What adverse effects result from testing a person for proteinuria? (4) Does treatment of proteinuria as a result of testing provide an incremental benefit in health outcomes? and (5) What adverse effects result from treating a person for proteinuria? The systematic search specifically targeted meta-analyses and systematic reviews. Findings: The systematic review revealed no direct evidence that testing for proteinuria among patients with CKD reduced incidence of end-stage renal disease (ESRD). However, the strong links between testing, treatment, and outcome suggest a correlation between proteinuria testing and ESRD. Conclusions: Current evidence suggests that proteinuria testing (using the albumin-to-creatinine ratio [ACR]) among patients with CKD would be an appropriate health care quality performance measure for improving patient outcomes. Copyright 2012",

author = "Thorp, {Micah L.} and Smith, {David H.} and Johnson, {Eric S.} and Suma Vupputuri and Weiss, {Jessica W.} and Petrik, {Amanda F.} and Xuihai Yang and Levey, {Andrew S.} and Haimanot Wasse and Rosemary Muoneke and Snyder, {Susan R.}",

note = "Funding Information: This project was funded by a cooperative agreement through the Centers for Disease Control and Prevention. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry (CDC/ATSDR). The authors thank Lesley A. Stevens, MD, Division of Nephrology, Tufts Medical Center, Boston; and Shirley L. Welch, PhD, Kaiser Permanente Northwest Regional Clinical Laboratory, Portland, Oregon, for their expert reviews of previous versions of this manuscript. ",

year = "2012",

month = jun,

doi = "10.1016/s1553-7250(12)38035-5",

language = "English (US)",

volume = "38",

pages = "277--282",

journal = "Joint Commission Journal on Quality and Patient Safety",

issn = "1553-7250",

publisher = "Joint Commission Resources, Inc.",

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TY - JOUR

T1 - Proteinuria among patients with chronic kidney disease

T2 - A performance measure for improving patient outcomes

AU - Thorp, Micah L.

AU - Smith, David H.

AU - Johnson, Eric S.

AU - Vupputuri, Suma

AU - Weiss, Jessica W.

AU - Petrik, Amanda F.

AU - Yang, Xuihai

AU - Levey, Andrew S.

AU - Wasse, Haimanot

AU - Muoneke, Rosemary

AU - Snyder, Susan R.

N1 - Funding Information: This project was funded by a cooperative agreement through the Centers for Disease Control and Prevention. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry (CDC/ATSDR). The authors thank Lesley A. Stevens, MD, Division of Nephrology, Tufts Medical Center, Boston; and Shirley L. Welch, PhD, Kaiser Permanente Northwest Regional Clinical Laboratory, Portland, Oregon, for their expert reviews of previous versions of this manuscript.

PY - 2012/6

Y1 - 2012/6

N2 - Background: In an effort to improve identification and treatment of patients with chronic kidney disease (CKD), the National Kidney Foundation (NKF) developed the Kidney Disease Quality Outcomes Initiative (KDQOI) clinical practice guidelines, which include measurement of proteinuria among all patients with CKD who are not receiving chronic dialysis therapy. Encouraging dissemination and utilization of these guidelines may be enhanced by the development of performance measures. The question of whether adequate evidence exists to advocate for the measurement of proteinuria in CKD as a performance measure was explored. Methods: The US Preventive Services Task Force "chain of evidence" framework was used to guide evidence synthesis from the systematic review. Five questions were applied to specific links in the evidence chain: (1) Is there direct evidence that testing for proteinuria improves health outcomes? (2) What is the yield of testing, in terms of both accuracy and reliability of the test and the prevalence of undiagnosed proteinuria? (3) What adverse effects result from testing a person for proteinuria? (4) Does treatment of proteinuria as a result of testing provide an incremental benefit in health outcomes? and (5) What adverse effects result from treating a person for proteinuria? The systematic search specifically targeted meta-analyses and systematic reviews. Findings: The systematic review revealed no direct evidence that testing for proteinuria among patients with CKD reduced incidence of end-stage renal disease (ESRD). However, the strong links between testing, treatment, and outcome suggest a correlation between proteinuria testing and ESRD. Conclusions: Current evidence suggests that proteinuria testing (using the albumin-to-creatinine ratio [ACR]) among patients with CKD would be an appropriate health care quality performance measure for improving patient outcomes. Copyright 2012

AB - Background: In an effort to improve identification and treatment of patients with chronic kidney disease (CKD), the National Kidney Foundation (NKF) developed the Kidney Disease Quality Outcomes Initiative (KDQOI) clinical practice guidelines, which include measurement of proteinuria among all patients with CKD who are not receiving chronic dialysis therapy. Encouraging dissemination and utilization of these guidelines may be enhanced by the development of performance measures. The question of whether adequate evidence exists to advocate for the measurement of proteinuria in CKD as a performance measure was explored. Methods: The US Preventive Services Task Force "chain of evidence" framework was used to guide evidence synthesis from the systematic review. Five questions were applied to specific links in the evidence chain: (1) Is there direct evidence that testing for proteinuria improves health outcomes? (2) What is the yield of testing, in terms of both accuracy and reliability of the test and the prevalence of undiagnosed proteinuria? (3) What adverse effects result from testing a person for proteinuria? (4) Does treatment of proteinuria as a result of testing provide an incremental benefit in health outcomes? and (5) What adverse effects result from treating a person for proteinuria? The systematic search specifically targeted meta-analyses and systematic reviews. Findings: The systematic review revealed no direct evidence that testing for proteinuria among patients with CKD reduced incidence of end-stage renal disease (ESRD). However, the strong links between testing, treatment, and outcome suggest a correlation between proteinuria testing and ESRD. Conclusions: Current evidence suggests that proteinuria testing (using the albumin-to-creatinine ratio [ACR]) among patients with CKD would be an appropriate health care quality performance measure for improving patient outcomes. Copyright 2012

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Proteinuria among patients with chronic kidney disease: A performance measure for improving patient outcomes

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