Treatment needs and diagnosis awareness in primary care patients with chronic kidney disease

Abstract

Background: GPs in England are required to keep a register of patients with chronic kidney disease (CKD). National Institute for Health and Clinical Excellence (NICE) guidelines recommend regular follow-up, but patients are perceived to be low risk and not requiring activemanagement. Aim: To assess treatment needs of CKD stage 3 patients in primary care, as well as their awareness of CKD. Design and setting: A cross-sectional analysis froma longitudinal prospective study in 32 general practices. Method: A total of 1741 participants underwent clinical assessment including urine and blood tests. Participants were asked about awareness of their CKD. Results were reviewed and a letter recommending treatment in line withNICE guidelines was sent to their GP. Results: Themean age of participants was 73 ± 9 years; 60%( n= 1052) were female and diabetes was present in 17%; 67%of participants required further intervention.Most required improved control of hypertension ( n= 1576; 33.1%of cohort). Other recommendations included advice to investigate anaemia ( n= 1142; 8.2%) or stop nephrotoxic drugs ( n= 1120; 7.5%). Less than 6%of participantsmet NICE criteria for referral to nephrology services and 41% were unaware of their CKD diagnosis. Multivariable analysis identified subjects with formal educational qualifications, age <75 years, estimated glomerular filtration rate (eGFR) 30-44 ml/min/1.73m 2, and significant albuminuria asmore likely to be aware of their diagnosis. Conclusion: The study data show that themajority of patients required at least one intervention to improve the management of their CKD. Most interventions could be delivered in primary care and only a minority required nephrology referral. Many patients were unaware of their CKD diagnosis, and efforts should bemade to improve this to facilitate involvement in their care. ©British Journal of General Practice.