Resident doctors’ knowledge and practice of chronic kidney disease: diagnosis and referral pattern

Abstract

Background: The prevalence of chronic kidney disease (CKD) in Nigeria is on the increase. Most patients with CKD present first to nonnephrologists and later to nephrologists with complications or in end-stage renal disease (ESRD). To prevent early progression of CKD to ESRD, early diagnosis, optimal care and timely referral to nephrologists are crucial. The aim of this study is to assess the knowledge of CKD diagnosis, care and referral practices amongst resident doctors in Nigeria. Methods: Self administered questionnaires were distributed to resident doctors in diverse subspecialties attending an update course on medical ethics organized by the West African College of Physicians in August 2013 at the main auditorium in University College Hospital, Ibadan Nigeria. The questionnaires were designed to elicit their knowledge of CKD diagnosis, common causes of CKD, screening of patients at risk of CKD, target blood pressure control and referral pattern. Results: Three hundred and forty (340) questionnaires were analyzed. Respondents were spread across the six geopolitical zones of Nigeria and different sub-specialties. These comprised of 24.4% in internal medicine 17.4% in paediatrics, 16.8%, 30% and 11.4%, in community medicine, family medicine and surgery respectively. Among the respondents, 280 (82.3%) would use glomerular filtration rate (GFR) as the main diagnostic criterion for CKD while its use as an indicator for assessing the severity of CKD was considered by 282 (82.9%). Up to 68.8% did not know the correct blood pressure targets in CKD management. Furthermore, 27.4% of the respondents would
use GFR in making decisions for referrals while 60.9% would use serum creatinine in taking such decisions. For referral to nephrologist, 40.6% would refer completely to the nephrologist, 55.4% would consider comanagement while 4% did not intend to refer to the nephrologist at all. The mean scores of knowledge of the internal medicine residents was significantly higher than that of non-internal medicine residents (p < 0.01). Conclusion: Resident doctors in Nigeria have good knowledge of CKD diagnosis and criteria for referral to a nephrologist. Internal medicine residents have better knowledge of CKD diagnosis, screening and nephrology referral compared to residents in other specialties.