SP282CKD GP REFERRALS PRE & POST NICE CKD GUIDANCE 2014

Abstract

INTRODUCTION AND AIMS: Mortality from chronic renal failure (CRF) is increasing Worldwide and is currently ranked 14th commonest cause of death1. Most patients die from cardiovascular disease, and management of cardiovascular risk is key to preventing both death and also decline of renal function to the point of end stage renal failure. In the UK 14% of men and 13% women have CRF, the majority being managed in primary care. In 2014, NICE introduced guidance to help GPs(General Practitioners) manage patients with CRF, focussing on cardiovascular risks and prevention of late referral of patients likely to require renal replacement therapy2.We assessed management of cardiovascular risk and timeliness of referral in all new GP referrals to the renal clinic in 2012, and again in 2016, 2 years after the introduction of NICE CKD guidance in 2014. METHODS: All new GP referrals to the Dorset Renal Service in 2012 and 2016 were analysed. Data was collected on patient age, CKD stage and eGFR (at referral), renal imaging pre-referral, BP, smoking, BMI, HbA1C (in diabetic patients), and lipid assessment. All statistical analyses were performed using IBM SPSS Statistics version 24. A p value of less than 0.05 was considered significant RESULTS: 486 new GP referrals were received in 2012, and 574 in 2016 (18% increase post NICE CRF guideline).Data completion was 100% for renal imaging pre-referral; BP; BMI; diabetic status at referral and lipid assessment at referral. 2 patients in both cohorts did not have eGFR/renal stage assessments due to age (< 18 years), and 1 patient in the 2016 cohort refused blood testing. 1 diabetic patient in the 2012 cohort did not have HbA1c testing. CONCLUSIONS: GP referral of new patients to the renal clinic has increased since NICE CKD guidance. Fewer Stage 4 and 5 CKD patients are being referred, but the number of patients with eGFR < 20 ml/min/m2 has not decreased significantly (late CKD referrals). BP control has improved post-NICE and more patients have had cholesterol levels checked. More referred patients are obese. Smoking cessation and prereferral renal imaging have not improved.