Prevalence and management of chronic kidney disease in primary care patients in the UK

Jameson, K.; Jick, Susan S.; Hagberg, Katrina Wilcox; Ambegaonkar, Baishali; Giles, A.; O’Donoghue, Dónal

doi:10.1111/ijcp.12454

Cited by 27 publications

(26 citation statements)

References 36 publications

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“…One of the strengths of this study is that it is a large, population-based cohort, which is representative for the UK population. While patients with CKD, especially stages G4-G5, have regular check-ups with nephrologists, it was demonstrated by Jameson et al that the prevalence of CKD stages G3-G5 in 2010 in the CPRD was consistent with the prevalence found in other large cross-sectional studies and a national survey [21]. Furthermore, in this CPRD cohort, longitudinal data was available for risk factors allowing adjustment for several confounders including comorbidities, falling, risk factors for osteoporosis, use of drugs and lifestyle factors.…”

Section: Discussionsupporting

confidence: 67%

The risk of new fragility fractures in patients with chronic kidney disease and hip fracture—a population-based cohort study in the UK

et al. 2020

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Chronic kidney disease (CKD) is a risk factor for fractures. However, in hip fracture patients, CKD G3-G5 was associated with a higher mortality risk and not associated with a higher risk of subsequent non-hip fractures compared to eGFR > 60 ml/min. The higher mortality risk may, as competing risk, explain our findings. Introduction Chronic kidney disease (CKD) is a known risk factor for fragility fractures. Patients aged 50+ with a recent fragility fracture have an increased risk of subsequent fractures. Our aim was to evaluate the association between CKD stages G3-G5 versus estimated glomerular filtration rate (eGFR) > 60 ml/min and the risk of a new non-hip fracture or fragility fracture in patients with a first hip fracture. Methods Population-based cohort study using the UK general practices in the Clinical Practice Research Datalink. Associations between CKD stage and first subsequent fracture were determined using Cox proportional hazard analyses to estimate hazard ratios (HRs). To explore the potential competing risk of mortality, cause-specific (cs) HRs for mortality were estimated. Results CKD G3-G5 was associated with a lower risk of any subsequent non-hip fracture (HR: 0.90, 95%CI: 0.83-0.97), but not with the risk of subsequent major non-hip fragility fracture. CKD G3-G5 was associated with a higher mortality risk (cs-HR: 1.05, 95%CI: 1.01-1.09). Mortality risk was 1.5-to 3-fold higher in patients with CKD G4 (cs-HR: 1.50, 95%CI: 1.38-1.62) and G5 (cs-HR: 2.93, 95%CI: 2.48-3.46) compared to eGFR > 60 ml/min. Conclusions The risk of a subsequent major non-hip fragility fractures following hip fracture was not increased in patients with CKD G3-G5 compared to eGFR > 60 ml/min. Mortality risk was higher in both hip fracture and non-hip fracture patients with CKD G4 and G5. The higher mortality risk may, as competing risk, explain our main finding of no increased or even decreased subsequent fracture risk after a hip fracture in patients with CKD G3-G5.

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Section: Discussionsupporting

confidence: 67%

The risk of new fragility fractures in patients with chronic kidney disease and hip fracture—a population-based cohort study in the UK

et al. 2020

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“…Despite strong evidence for the efficacy of ACEI/ARB to reduce proteinuria and slow progression of CKD to ESKD, less than 70% of Australian adult patients with CKD stages 3-5 with diabetes and microalbuminuria were receiving an ACEI or ARB. The prescribing of an ACEI or ARB in patients with CKD with albuminuria was slightly lower in Australian general practice compared to that reported in other developed nations [24][25][26][27]. Studies from different provinces of Canada [24][25][26] investigating prescribing in CKD patients reported rates of 74% to 80% for ACEI or ARB prescribing, while a study conducted in the Netherlands found prescribing in 78% and 82% of non-diabetes and diabetes patients, respectively [11].…”

Section: Discussionmentioning

confidence: 87%

Medication Prescribing Quality in Australian Primary Care Patients with Chronic Kidney Disease

Bezabhe

Kitsos

Saunder

et al. 2020

JCM

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Background: Australian patients with chronic kidney disease (CKD) are routinely managed in general practices with multiple medications. However, no nationally representative study has evaluated the quality of prescribing in these patients. The objective of this study was to examine the quality of prescribing in patients with CKD using nationally representative primary care data obtained from the NPS MedicineWise’s dataset, MedicineInsight. Methods: A cross-sectional analysis of general practice data for patients aged 18 years or older with CKD was performed from 1 February 2016 to 1 June 2016. The study examined the proportion of patients with CKD who met a set of 16 published indicators in two categories: (1) potentially appropriate prescribing of antihypertensives, renin-angiotensin system (RAS) inhibitors, phosphate binders, and statins; and (2) potentially inappropriate prescribing of nephrotoxic medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), at least two RAS inhibitors, triple therapy (an NSAID, a RAS inhibitor and a diuretic), high-dose digoxin, and metformin. The proportion of patients meeting each quality indicator was stratified using clinical and demographic characteristics. Results: A total of 44,259 patients (24,165 (54.6%) female; 25,562 (57.8%) estimated glomerular filtration (eGFR) 45–59 mL/1.73 m2) with CKD stages 3–5 were included. Nearly one-third of patients had diabetes and were more likely to have their blood pressure and albumin-to-creatinine ratio monitored than those without diabetes. Potentially appropriate prescribing of antihypertensives was achieved in 79.9% of hypertensive patients with CKD stages 4–5. The prescribing indicators for RAS inhibitors in patients with microalbuminuria and diabetes and in patients with macroalbuminuria were achieved in 69.9% and 62.3% of patients, respectively. Only 40.8% of patients with CKD and aged between 50 and 65 years were prescribed statin therapy. The prescribing of a RAS inhibitor plus a diuretic was less commonly achieved, with the indicator met in 20.6% for patients with microalbuminuria and diabetes and 20.4% for patients with macroalbuminuria. Potentially inappropriate prescribing of NSAIDs, metformin, and at least two RAS inhibitors were apparent in 14.3%, 14.1%, and 7.6%, respectively. Potentially inappropriate prescribing tended to be more likely in patients aged ≥65 years, living in regional or remote areas, or with socio-economic indexes for areas (SEIFA) score ≤ 3. Conclusions: We identified areas for possible improvement in the prescribing of RAS inhibitors and statins, as well as deprescribing of NSAIDs and metformin in Australian general practice patients with CKD.

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“…The majority based their definitions on the estimated glomerular filtration rate (eGFR) and stages as defined by KDIGO and KDOQI, while others used creatinine clearance rate, serum creatinine, albuminuria/proteinuria measurements, or International Classification of Diseases‐codes . Some studies used combinations of measurements and/or codes . Some papers did not specify the definition of CKD but referred to guidelines using the KDOQI staging .…”

Section: Resultsmentioning

confidence: 99%

Process quality indicators for chronic kidney disease risk management: a systematic literature review

et al. 2016

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Prevalence and management of chronic kidney disease in primary care patients in the UK

Cited by 27 publications

References 36 publications

The risk of new fragility fractures in patients with chronic kidney disease and hip fracture—a population-based cohort study in the UK

The risk of new fragility fractures in patients with chronic kidney disease and hip fracture—a population-based cohort study in the UK

Medication Prescribing Quality in Australian Primary Care Patients with Chronic Kidney Disease

Process quality indicators for chronic kidney disease risk management: a systematic literature review

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