TY - JOUR T1 - Kidney trajectory charts to assist general practitioners in the assessment of patients with reduced kidney function: a randomised vignette study JF - BMJ Evidence-Based Medicine JO - BMJ EBM DO - 10.1136/bmjebm-2021-111767 SP - bmjebm-2021-111767 AU - Michelle Guppy AU - Paul Glasziou AU - Elaine Beller AU - Richard Flavel AU - Jonathan E Shaw AU - Elizabeth Barr AU - Jenny Doust Y1 - 2021/12/21 UR - http://ebm.bmj.com/content/early/2021/12/21/bmjebm-2021-111767.abstract N2 - Objective To investigate the decisional impact of an age-based chart of kidney function decline to support general practitioners (GPs) to appropriately interpret estimated glomerular filtration rate (eGFR) and identify patients with a clinically relevant kidney problem.Design and setting Randomised vignette studyParticipants 372 Australian GPs from August 2018 to November 2018.Intervention GPs were given two patient case scenarios: (1) an older woman with reduced but stable renal function and (2) a younger Aboriginal man with declining kidney function still in the normal range. One group was given an age-based chart of kidney function to assist their assessment of the patient (initial chart group); the second group was asked to assess the patients without the chart, and then again using the chart (delayed chart group).Main outcome measures GPs’ assessment of the likelihood—on a Likert scale—that the patients had chronic kidney disease (CKD) according to the usual definition or a clinical problem with their kidneys.Results Prior to viewing the age-based chart GPs were evenly distributed as to whether they thought case 1—the older woman—had CKD or a clinically relevant kidney problem. GPs who had initial access to the chart were less likely to think that the older woman had CKD, and less likely to think she had a clinically relevant problem with her kidneys than GPs who had not viewed the chart. After subsequently viewing the chart, 14% of GPs in the delayed chart group changed their opinion, to indicate she was unlikely to have a clinically relevant problem with her kidneys.Prior to viewing the chart, the majority of GPs (66%) thought case 2—the younger man—did not have CKD, and were evenly distributed as to whether they thought he had a clinically relevant kidney problem. In contrast, GPs who had initial access to the chart were more likely to think he had CKD and the majority (72%) thought he had a clinically relevant kidney problem. After subsequently viewing the chart, 37% of GPs in the delayed chart group changed their opinion to indicate he likely had a clinically relevant problem with his kidneys.Conclusions Use of the chart changed GPs interpretation of eGFR, with increased recognition of the younger male patient’s clinically relevant kidney problem, and increased numbers classifying the older female patient’s kidney function as normal for her age. This study has shown the potential of an age-based kidney function chart to reduce both overdiagnosis and underdiagnosis.Data are available upon reasonable request. Data are anonymous participant questionnaire responses, and are available by contacting MG at mguppy2@une.edu.au. ER -