Screening for CKD To Improve Processes of Care among Nondiabetic Veterans with Hypertension: A Pragmatic Cluster-Randomized Trial.

Background And Objectives: We conducted a pilot, pragmatic, cluster-randomized trial to evaluate feasibility and preliminary effectiveness of screening for CKD using a triple-marker approach (creatinine, cystatin C, and albumin/creatinine ratio), followed by education and guidance, to improve care of hypertensive veterans in primary care. We used the electronic health record for identification, enrollment, intervention delivery, and outcome ascertainment.

Design, Setting, Participants, & Measurements: We randomized 1819 veterans without diabetes but with hypertension (41 clusters) into three arms: () CKD screening followed by patient and provider education; () screening, education, plus pharmacist comanagement; or () usual care.

Validating laboratory defined chronic kidney disease in the electronic health record for patients in primary care.

Background: Electronic health record (EHR) data is increasingly used to identify patients with chronic kidney disease (CKD). EHR queries used to capture CKD status, identify comorbid conditions, measure awareness by providers, and track adherence to guideline-concordant processes of care have not been validated.

Methods: We extracted EHR data for primary-care patients with two eGFRcreat 15-59 mL/min/1.

Implementation of a pragmatic randomized trial of screening for chronic kidney disease to improve care among non-diabetic hypertensive veterans.

Background: Whether screening for chronic kidney disease (CKD) can improve the care of persons at high risk for complications remains uncertain. We describe the design and early implementation experience of a pilot, cluster-randomized pragmatic trial to evaluate the feasibility, implementation, and effectiveness of a "triple marker" CKD screening program (creatinine, cystatin C and albumin to creatinine ratio) for improving care among hypertensive veterans seen in primary care at one Veterans Administration Hospital.

Methods/design: Non-diabetic hypertensive veterans age 18-80 without known CKD were randomized in clusters determined by primary care provider (unit of randomization) into three arms.

A longitudinal study of overweight, elevated blood pressure, and acanthosis nigricans among low-income middle school students.

This longitudinal study examined the rates of overweight, elevated blood pressure, acanthosis nigricans, and their associated factors in third through fifth grade students over 4 years. Participants consisted of 279 students who participated in health screenings in 2002 and 2006. Hispanic students had significantly higher rates of overweight and acanthosis nigricans compared to White students.