Survey on determination of albuminuria by family physicians

Objective: Albuminuria is an established marker of cardiovascular (CV) risk which has a role in pathogenesis of cardio-renal diseases, and it is questioned whether it should also be a therapy target. In all relevant guidelines it is listed as a routine laboratory method for all patients with hypertension and increased CV risk regardless they have diabetes or not. Croatian Hypertension League successfully negotiated with Croatian National Health Insurance company, and since last February determination of albumin-to-creatinine ratio - ACR is reimbursed for all patients with hypertension, and not only hospital specialist, but also family physicians (FP) are allowed to use this method. We announced this important novelty through our newsletters, website and media. The aim was to analyze how this method was implemented by family physicians in regular work. Design and method: A digital structured questionnaire was prepared and placed at the website of the Croatian Hypertension League. Using our regular monthly newsletter, we have invited FP, members of the League to participate in this survey. So far, 135 FP participated (83.7% women) from all parts of Croatia. Results: All physicians believe that determination of ACR is very important. Before this survey, 34% have not heard about this possibility, and from those who were informed 31% have not yet started. The most important reason was incapability of local laboratory (51%) followed by the answer that they have not had proper patient for these analyses (17.8%). When asked whether their laboratory provide them with values of estimated glomerular filtration rate, 51% answered negatively. Conclusions: Croatian Hypertension League made a big step forward enabling determination of ACR for all hypertensive patients by all physicians. However, there are still several gaps which should be eliminated. One is increasing awareness of FP and encouraging them to determine ACR more frequently, and the other one is to convince medical biochemistries to allow regular determination of ACR in all laboratories, but also of reporting eGFR. Survey, like this are very important and could be helpful in reaching final success, and we will use results for evidence-based negotiation with Croatian Biochemistry Chamber.