The impact of population-based identification of chronic kidney disease using estimated glomerular filtration rate (eGFR) reporting

Richards, Nick; Harris, Kevin; Whitfield, Michael F.; O’Donoghue, Dónal; Lewis, Robert; Mansell, M. A.; Thomas, Stephen; Townend, Jonathan N.; Eames, Mick; Marcelli, Daniele

doi:10.1093/ndt/gfm839

Cited by 61 publications

(54 citation statements)

References 15 publications

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“…13,14 Others assessed the prevalence of CKD in the general population was about 5-7%. 7,8 However, the validity of these prevalence estimates was impaired by incomplete eGFR and albuminuria data. 7,8 In this study, the focus was on high-risk primary care patients (that is, with diabetes or hypertension) in order to identify the proportion of people with CKD in candidate risk groups.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…7,8 However, the validity of these prevalence estimates was impaired by incomplete eGFR and albuminuria data. 7,8 In this study, the focus was on high-risk primary care patients (that is, with diabetes or hypertension) in order to identify the proportion of people with CKD in candidate risk groups. 1,15 In patients with hypertension only, the screening uptake rate was lower (87%) than in patients with diabetes (97%).…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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Chronic kidney disease in patients with diabetes mellitus type 2 or hypertension in general practice

Meer¹,

Wielders²,

Grootendorst³

et al. 2010

Br J Gen Pract

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The prevalence and severity of chronic kidney disease (CKD) in primary care patients with diabetes or hypertension is unknown. AimTo assess the prevalence and severity of CKD in patients with diabetes and hypertension; and identify whether age, sex, diabetes, and hypertension are associated with CKD. Design of studyCross-sectional survey. SettingTwo Dutch primary health care centres (15 954 enlisted patients). MethodPatients, aged ≥25 years, with known diabetes type 2 (n = 471) or hypertension (n = 960), were selected on 1 October 2006. Initial screening uptake rates were assessed from the electronic patient records, and patients were invited when blood or urine measurements were missing. The presence of albuminuria was determined, glomerular filtration rate estimated, and clinical characteristics extracted. ResultsInitial screening uptake rates were 93% and 69% for diabetes and hypertension, respectively, and increased to 97% (n = 455) and 87% (n = 836) after active invitation. The prevalence of CKD was 28% in diabetes and 21% in hypertension only. The presence of diabetes was independently associated with albuminuria (odds ratio [OR] 4.23; 95% confidence interval [CI] = 2.67 to 6.71), but not with decreased estimated GFR (eGFR) (OR 0.75; 95% CI = 0.54 to 1.04). Age showed the strongest association with decreased eGFR (OR 2.73; 95% CI = 2.02 to 3.70). ConclusionIn primary care, more than one-quarter of patients with diabetes and about one-fifth of patients with hypertension have CKD. The high prevalence justifies longitudinal follow-up in order to evaluate whether intensified cardiovascular risk management is beneficial in this primary care population.

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Section: Comparison With Existing Literaturementioning

confidence: 99%

Section: Comparison With Existing Literaturementioning

confidence: 99%

Chronic kidney disease in patients with diabetes mellitus type 2 or hypertension in general practice

Meer¹,

Wielders²,

Grootendorst³

et al. 2010

Br J Gen Pract

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“…This trend of excessive referral was reversed by combining eGFR reporting with a primary-care-based disease management program that is guideline and algorithm based. 9 The combination of GFR with disease management program also showed an improvement in the management of CKD: dyslipidemia, blood pressure control, and decline in GFR. 10 Glassock et al 11 questioned the utility of universal screening for CKD using eGFR and highlighted the danger of the erroneous categorization of patients "as having an intermediate stage of a lethal disease" specifically elderly females and suggested that targeted screening for CKD (patients with risk factors for CKD) could be more cost-effective.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Reporting Estimated Glomerular Filtration Rate

et al. 2011

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The 'Kidney Disease Outcomes Quality Initiative' guidelines recommend laboratory reporting of a calculated estimated glomerular filtration rate (eGFR). The United Kingdom and several states already mandate reporting eGFR for every laboratory serum creatinine (sCr) measurement. In our study, we evaluated the impact of reporting eGFR on the management of hospitalized patients. We reviewed the medical records for 2000 patients, 1000 pre-and 1000 post-reporting eGFR. We excluded patients with previous diagnosis of chronic kidney disease, acute kidney failure, and end-stage renal disease. We analyzed the subgroup of patients with eGFR <60 and sCr <1.5 mg/dL. We did not notice an increase in the number of renal consult, ordering laboratory or imaging study to evaluate chronic kidney disease. The prescription habits did not change for nephrotoxic medications (nonsteroidal anti-inflammatory drugs and aminoglycosides). We did not find any change in the percentage of patients who received hydration for a radiological contrast study or the use of N-acetylcysteine. In conclusion, reporting eGFR did not improve the renal management of hospitalized patients.

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“…Almost one in four patients in the United Kingdom present to nephrology care within 3 mos of requiring renal replacement therapy (RRT) (5), with poor outcomes in terms of morbidity and mortality, as well as compromised ability to make timely plans regarding access, modality, or appropriateness of RRT (6). The vast majority of patients with CKD are treated solely through primary care, with one study finding that less than 4% of patients with CKD, identified from routine blood tests, were receiving nephrology care (7). We argue that reporting of eGFR improves recognition of CKD and allows risk stratification and timely management of its complications.…”

Section: W E Read With Interest the Articles Regarding Egfr Reportingmentioning

confidence: 99%

Perspectives on eGFR reporting from the Interface between Primary and Secondary Care

Cheung

Bhandari

2009

Clinical Journal of the American Society of Nephrology

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The introduction of estimated GFR (eGFR) reporting based on the Modification of Diet in Renal Disease (MDRD) equation has caused much debate regarding its value in the wider community. In particular, automated reporting of eGFR by laboratories has led to concern that it is being used as a "covert " screening tool, in populations in which the MDRD equation has known inaccuracies. There is a fear of creating a population of "worried well, " with potential impact on patients and implications for the use of resources. It is established that in certain groups, chronic kidney disease confers a greatly increased risk of cardiovascular disease, yet risk factors remain inadequately managed. We believe that eGFR reporting allows the opportunity to stratify risk and improve outcome among a wide population.

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The impact of population-based identification of chronic kidney disease using estimated glomerular filtration rate (eGFR) reporting

Cited by 61 publications

References 15 publications

Chronic kidney disease in patients with diabetes mellitus type 2 or hypertension in general practice

Chronic kidney disease in patients with diabetes mellitus type 2 or hypertension in general practice

The Impact of Reporting Estimated Glomerular Filtration Rate

Perspectives on eGFR reporting from the Interface between Primary and Secondary Care

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