How do primary care doctors in England and Wales code and manage people with chronic kidney disease? Results from the National Chronic Kidney Disease Audit

Abstract

BackgroundIn the UK, primary care records are electronic and require doctors to ascribe disease codes to direct care plans and facilitate safe prescribing. We investigated factors associated with coding of chronic kidney disease (CKD) in patients with reduced kidney function and the impact this has on patient management.MethodsWe identified patients meeting biochemical criteria for CKD (two estimated glomerular filtration rates <60 mL/min/1.73 m2 taken >90 days apart) from 1039 general practitioner (GP) practices in a UK audit. Clustered logistic regression was used to identify factors associated with coding for CKD and improvement in coding as a result of the audit process. We investigated the relationship between coding and five interventions recommended for CKD: achieving blood pressure targets, proteinuria testing, statin prescription and flu and pneumococcal vaccination.ResultsOf 256 000 patients with biochemical CKD, 30% did not have a GP CKD code. Males, older patients, those with more severe CKD, diabetes or hypertension or those prescribed statins were more likely to have a CKD code. Among those with continued biochemical CKD following audit, these same characteristics increased the odds of improved coding. Patients without any kidney diagnosis were less likely to receive optimal care than those coded for CKD [e.g. odds ratio for meeting blood pressure target 0.78 (95% confidence interval 0.76–0.79)].ConclusionOlder age, male sex, diabetes and hypertension are associated with coding for those with biochemical CKD. CKD coding is associated with receiving key primary care interventions recommended for CKD. Increased efforts to incentivize CKD coding may improve outcomes for CKD patients.

Prevalence of anemia in patients with chronic kidney disease in Japan: A nationwide, cross-sectional cohort study using data from the Japan Chronic Kidney Disease Database (J-CKD-DB)

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“…To our knowledge, no studies have examined pan-Canadian performance in meeting quality-of-care indicators for CKD management in primary care, as has been done in other settings. 14,15,16,17…”

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“…1 Despite being a well-established risk factor for cardiovascular disease (CVD) mortality, even in its early stages, 2 CKD remained an underdiagnosed condition, causing delays in treatment and worsening of outcomes. 3,4 Typically, CKD refers to impaired kidney function and low glomerular filtration rates. However, also abnormally elevated glomerular filtration rates, known as renal hyperfiltration (RHF), appear to be an early sign of CKD and a predictor of mortality, cardiovascular diseases, and diabetes.…”