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Wagner M, Wanner C, Schich M, Kotseva K, Wood D, Hartmann K, Fette G, Rücker V, Oezkur M, Störk S, Heuschmann PU. Patient's and physician's awareness of kidney disease in coronary heart disease patients - a cross-sectional analysis of the German subset of the EUROASPIRE IV survey. BMC Nephrol 2017; 18:321. [PMID: 29070030 PMCID: PMC5657122 DOI: 10.1186/s12882-017-0730-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 09/29/2017] [Indexed: 11/17/2022] Open
Abstract
Background Chronic kidney disease (CKD) is a common comorbid condition in coronary heart disease (CHD). CKD predisposes the patient to acute kidney injury (AKI) during hospitalization. Data on awareness of kidney dysfunction among CHD patients and their treating physicians are lacking. In the current cross-sectional analysis of the German EUROASPIRE IV sample we aimed to investigate the physician’s awareness of kidney disease of patients hospitalized for CHD and also the patient’s awareness of CKD in a study visit following hospital discharge. Methods All serum creatinine (SCr) values measured during the hospital stay were used to describe impaired kidney function (eGFRCKD-EPI < 60 ml/min/1.73m2) at admission, discharge and episodes of AKI (KDIGO definition). Information extracted from hospital discharge letters and correct ICD coding for kidney disease was studied as a surrogate of physician’s awareness of kidney disease. All patients were interrogated 0.5 to 3 years after hospital discharge, whether they had ever been told about kidney disease by a physician. Results Of the 536 patients, 32% had evidence for acute or chronic kidney disease during the index hospital stay. Either condition was mentioned in the discharge letter in 22%, and 72% were correctly coded according to ICD-10. At the study visit in the outpatient setting 35% had impaired kidney function. Of 158 patients with kidney disease, 54 (34%) were aware of CKD. Determinants of patient’s awareness were severity of CKD (OReGFR 0.94; 95%CI 0.92–0.96), obesity (OR 1.97; 1.07–3.64), history of heart failure (OR 1.99; 1.00–3.97), and mentioning of kidney disease in the index event’s hospital discharge letter (OR 5.51; 2.35–12.9). Conclusions Although CKD is frequent in CHD, only one third of patients is aware of this condition. Patient’s awareness was associated with kidney disease being mentioned in the hospital discharge letter. Future studies should examine how raising physician’s awareness for kidney dysfunction may improve patient’s awareness of CKD.
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Affiliation(s)
- Martin Wagner
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Petrinistr. 33a, 97080, Würzburg, Germany. .,Division of Nephrology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany. .,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.
| | - Christoph Wanner
- Division of Nephrology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Martin Schich
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Petrinistr. 33a, 97080, Würzburg, Germany.,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Kornelia Kotseva
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.,Department of Public Health, University of Ghent, Ghent, Belgium.,Fellow of the European Society of Cardiology, Sophia Antipolis, France
| | - David Wood
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Katrin Hartmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Petrinistr. 33a, 97080, Würzburg, Germany.,Division of Nephrology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Georg Fette
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Institute of Informatics VI, University of Würzburg, Würzburg, Germany
| | - Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Petrinistr. 33a, 97080, Würzburg, Germany
| | - Mehmet Oezkur
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Division of Cardiology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Petrinistr. 33a, 97080, Würzburg, Germany.,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
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Campanella F, Rossi L, Giroletti E, Micheletti P, Buzzi F, Villani S. Are physicians aware enough of patient radiation protection? Results from a survey among physicians of Pavia District- Italy. BMC Health Serv Res 2017; 17:406. [PMID: 28615014 PMCID: PMC5471682 DOI: 10.1186/s12913-017-2358-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 06/06/2017] [Indexed: 12/25/2022] Open
Abstract
Background Radiological practices are the first anthropic sources of ionizing radiation exposure of the population. However, a review of recent publications underlines inadequate doctors’ knowledge about doses imparted in medical practices and about patient protection that might explain unnecessary radiological prescriptions. We investigated the knowledge of the physicians of Pavia District (Italy) on the risk of radiation exposure. Methods A cross sectional study was performed involving the Medical Association of Pavia District. Data were collected with a self-administered questionnaire, available on-line with private login and password. Results Four hundred nineteen physicians fulfilled the questionnaire; 48% of participants reported training about radiation protection. The average percentage of correct answers on the knowledge on ionizing radiation was 62.29%, with a significantly higher result between radiologist. Around 5 and 13% of the responders do not know that, respectively, ultrasonography and magnetic resonance do not expose patients to ionizing radiations. Only 5% of the physicians properly identified the cancer risk rate associated to abdomen computed tomography. Conclusions The findings show a quite good level of the general knowledge about ionizing radiations, higher that reported in literature. Nevertheless, we believe the usefulness of training on the risk linked to radiation exposure in medicine for physicians employed in every area. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2358-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francesca Campanella
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100, Pavia, Italy.
| | - Laura Rossi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100, Pavia, Italy
| | - Elio Giroletti
- Department of Physics, University of Pavia, Via Bassi 6, 27100, Pavia, Italy.,INFN of Pavia, Via Bassi 6, 27100, Pavia, Italy
| | - Piero Micheletti
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100, Pavia, Italy
| | - Fabio Buzzi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100, Pavia, Italy
| | - Simona Villani
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100, Pavia, Italy
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