#3014 Primary care perspective on management of chronic kidney disease in Tunisia
Authors: Messaoud Faiza Ben , Sellami Nada , Saïed Salah , Hmida Fethi Ben , Abderrahim Ezzedine 
Published: May 2024

Abstract

Background and Aims
Chronic Kidney Disease (CKD) represents a significant public health challenge. The primary care physician holds a crucial position in facilitating its early detection, serving as a linchpin in the comprehensive management of patients often with multiple comorbidities. The objective of our study was to investigate CKD management in primary care practitioners in Tunisia and their relationship with nephrologists.

Method
We conducted a cross-sectional study involving family physicians and general practitioners. This involved a self-administered questionnaire using Google Forms, aiming to investigate CKD management in the context of primary care in Tunisia, along with an examination of collaboration with nephrologists.

Results
Our study included 43 practitioners with a gender ratio of M/F = 0.3. The average age of participants was 30.7 years [25-53 years]. Of the 43 participants, 95% practiced in urban areas, and 74% were in training. They worked in university hospitals (53%), primary care centers (21%), regional hospitals (19%), and private practices (7%). When asked about their feelings during the management of a patient with CKD, the main response was anxiety (65%) followed by indifference (18%), confidence (12%), and fear (5%). According to practitioners, the uniqueness of CKD management was due to the polypathological nature of patients (79%), the difficulty in managing certain cases (74%), the difficulty in applying certain recommendations (60%), the lack of medications (2%), and the difficulty in accessing complementary tests in primary care (2%). The means of training and sources of information on CKD mentioned were specialized medical journals (49%), medical websites (40%), peer groups (4%), pharmaceutical industry representatives (2%), and no source (5%). The means of training included additional studies certificates (23%), workshops/plenary sessions (44%), specialized webinars (30%), intra-hospital medical days (46%), nephrology internships (28%), and no available means (16%). Regarding the relationship with the nephrologist in joint management, 42% had a corresponding nephrologist. Thirty percent declared no difficulty in referring patients to nephrology when necessary. In case of difficulty, it would be related to long delays in obtaining a consultation with the nephrologist (60%), the geographical distance of nephrology centers (30%), and sometimes patient refusal (23%). When discovering CKD, 60% immediately referred patients to the nephrologist. On a scale of 0 to 5, communication and coordination of care between nephrologists and primary care physicians were estimated at 0 by 12%, 1 by 16%, 2 by 30%, 3 by 30%, 4 by 12%. Regarding end stage CKD management, practitioners informed patients about kidney transplantation (9%), hemodialysis (53%), peritoneal dialysis (16%), and 55% stated they did not have to inform patients about these techniques. Sixty-three percent continued to follow patients after the initiation of renal replacement therapy.

Conclusion
Our work revealed that the predominant sentiment when dealing with CKD patients in primary care is anxiety. This emotion appears to stem from the intricate nature of CKD management, primarily associated with the polypathological profile of patients and challenges in implementing recommended guidelines, compounded by difficulties in accessing nephrologist consultations. The imperative challenge lies in enhancing information accessibility for practitioners to optimize CKD management within this medical context.