Potential impact of NICE guidelines on referrals from primary care to nephrology: a primary care database and prospective research study

The British journal of general practice: the journal of the Royal College of General Practitioners

article

Michael K Sullivan¹  Bhautesh Dinesh Jani²  Elaine Rutherford³  Paul Welsh¹  Alex McConnachie⁴  Rupert W Major⁵  David McAllister⁶  Dorothea Nitsch⁷  Frances S Mair²  Patrick B Mark¹  Jennifer S Lees¹ 

[1] Institute of Cardiovascular and Medical Sciences, University of Glasgow;General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow;Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, consultant in renal medicine, Renal Unit, Mountainhall Treatment Centre;Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow;Department of Cardiovascular Sciences, University of Leicester, Leicester, consultant nephrologist, John Walls Renal Unit, University Hospitals of Leicester;Public Health, Institute of Health and Wellbeing, University of Glasgow;Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine

关键词: diagnosis;    general practice;    guidelines;    hospital referrals;    large database research;    renal medicine;   

DOI  :  10.3399/BJGP.2022.0145

学科分类：卫生学

来源: Royal College of General Practitioners

【 摘 要 】

Background National Institute for Health and Care Excellence 2021 guidelines on chronic kidney disease (CKD) recommend the use of the Kidney Failure Risk Equation (KFRE), which includes measurement of albuminuria. The equation to calculate estimated glomerular filtration rate (eGFR) has also been updated.Aim To investigate the impact of the use of KFRE and the updated eGFR equation on CKD diagnosis (eGFR <60 mL/min/1.73 m2) in primary care and potential referrals to nephrology.Design and setting Primary care database (Secure Anonymised Information Linkage Databank [SAIL]) and prospective cohort study (UK Biobank) using data available between 2013 and 2020.Method CKD diagnosis rates were assessed when using the updated eGFR equation. Among people with eGFR 30–59 mL/min/1.73 m2 the following groups were identified: those with annual albuminuria testing and those who met nephrology referral criteria because of: a) accelerated eGFR decline or significant albuminuria; b) eGFR decline <30 mL/ min/1.73 m25% only. Analyses were stratified by ethnicity in UK Biobank.Results5% identified 182/61 721 (0.3%) patients at high risk of CKD progression before their eGFR declined and 361/61 721 (0.6%) low-risk patients who were no longer eligible for referral. Ethnic groups ‘Asian’ and ‘other’ had disproportionately raised KFREs.Conclusion Application of KFRE criteria in primary care will lead to referral of more patients at elevated risk of kidney failure (particularly among minority ethnic groups) and fewer low-risk patients. Albuminuria testing needs to be expanded to enable wider KFRE implementation.

【 授权许可】

Free