The National CKD Audit: a primary care condition that deserves more attention

Hull, Sally; Nitsch, Dorothea; Caplin, Ben; Griffith, K.; Wheeler, David C.

doi:10.3399/bjgp18x697997

Cited by 5 publications

(7 citation statements)

References 8 publications

(7 reference statements)

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“…Black patients have earlier onset ESKD (56.5 v 65.8 years) [ 56 ], and reduced pre-emptively listing for transplantation compared to White patients (odds ratio, 0.43) [ 54 , 55 ]. However in areas of high RRT uptake, rates of CKD diagnosis are low [ 57 ], which has also been reported in the USA, and overestimation due to eGFR equations in African Americans with ≥60 mls/min/1.73m 2 has been proposed to be contributory in keeping with our findings [ 37 , 56 , 58 – 61 ]. In a South African Black cohort approximately one in six patients would be not recognised as having CKD Stage 3 [ 36 ], and in a US cohort up to one in three Black patients were reclassified with a more severe CKD if unadjusted eGFR equations were used [ 60 ].…”

Section: Discussionsupporting

confidence: 89%

Estimated glomerular filtration rate equations in people of self-reported black ethnicity in the United Kingdom: Inappropriate adjustment for ethnicity may lead to reduced access to care

et al. 2021

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Assessment in African populations suggest adjustment for ethnicity in estimated glomerular filtration rate (eGFR) equations derived from African Americans lead to overestimation of GFR and failure to determine severity in chronic kidney disease (CKD). However, studies in African Europeans are limited. We aimed to assess accuracy of eGFR equations, with and without ethnicity adjustment compared with measured GFR in people of Black ethnicity in the United Kingdom. Performance of MDRD, CKD-EPI (with and without ethnicity adjustment), Full Age Spectrum (FAS), revised Lund Malmö (LM Revised), and European Kidney Function Consortium (EKFC) eGFR equations were assessed compared to 51Cr-EDTA GFR studies extracted from hospital databases. Participants with albumin <30g/l, liver disease, <18 years, of non-Black or non-White self-reported ethnicity were excluded. Agreement was assessed by bias, precision and 30%-accuracy and was stratified for ethnicity and GFR. 1888 51Cr-EDTA studies were included (Mean age-53.7yrs; 43.6% female; 14.1% Black ethnicity). Compared to White participants, eGFR-MDRD and eGFR-CKD-EPI equations in Black participants significantly overestimated GFR (bias 20.3 and 19.7 ml/min/1.73m2 respectively, p<0.001). Disregarding the ethnicity adjustment significantly improved GFR estimates for Black participants (bias 6.7 and 2.4ml/min/1.73m2 for eGFR-MDRD and eGFR-CKD-EPI respectively, p<0.001). The LM Revised equation had the smallest bias for both White and Black participants (5.8ml and -1.1ml/min/1.73m2 respectively). 30%-accuracy was superior for GFR≥60ml/min/1.73m2 compared to <60ml/min/1.73m2 using eGFR-CKD-EPI equation for both White and Black participants (p<0.001). Multivariate regression methodology with adjustment for age, sex and log(serum creatinine) in the cohort yielded an ethnicity coefficient of 1.018 (95% CI: 1.009–1.027). Overestimation of measured GFR with eGFR equations using ethnicity adjustment factors may lead to reduced CKD diagnosis and under-recognition of severity in people of Black ethnicity. Our findings suggest that ethnicity adjustment for GFR estimation in non-African Americans may not be appropriate for use in people of Black ethnicity in the UK.

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Section: Discussionsupporting

confidence: 89%

Estimated glomerular filtration rate equations in people of self-reported black ethnicity in the United Kingdom: Inappropriate adjustment for ethnicity may lead to reduced access to care

et al. 2021

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“… 3 In CKD, the majority of people are managed in primary care rather than by kidney specialists. 4 Long-term CKD management requires a high level of patient engagement, both in decision-making and in the implementation of care. 5 For those with CKD, this encompasses a spectrum of behaviours ranging from adherence to medication and diet recommendations, maintaining physical activity, recognition and monitoring of risk factors (eg, blood glucose and blood pressure) and self-adjustment of home-care routines.…”

Section: Introductionmentioning

confidence: 99%

“… 8 As such there remains a need for better and innovative self-management interventions for those with CKD. 4 8 Digital self-management interventions have the potential to improve remote disease management and health outcomes 17 and are increasingly becoming integrated into self-management to improve behaviour. The COVID-19 pandemic has also presented those with long-term conditions and their healthcare teams an opportunity to innovate and move towards an increasingly digitalised care, with particular emphasis on supporting patients from their own homes.…”

Section: Introductionmentioning

confidence: 99%

‘Self-Management Intervention through Lifestyle Education for Kidney health’ (the SMILE-K study): protocol for a single-blind longitudinal randomised controlled trial with nested pilot study

et al. 2022

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IntroductionMany people living with chronic kidney disease (CKD) are expected to self-manage their condition. Patient activation is the term given to describe the knowledge, skills and confidence a person has in managing their own health and is closely related to the engagement in preventive health behaviours. Self-management interventions have the potential to improve remote disease management and health outcomes. We are testing an evidence-based and theory-based digital self-management structured 10-week programme developed for peoples with CKD called ‘My Kidneys & Me’. The primary aim of the study (Self-Management Intervention through Lifestyle Education for Kidney health (SMILE-K)) is to assess the effect on patient activation levels.Methods and analysisA single-blind randomised controlled trial (RCT) with a nested pilot study will assess the feasibility of the intervention and study design before continuation to a full RCT. Individuals aged 18 years or older, with established CKD stage 3–4 (eGFR of 15–59 mL/min/1.73 m2) will be recruited through both primary and secondary care pathways. Participants will be randomised into two groups: intervention group (receive My Kidneys & Me in addition to usual care) and control group (usual care). The primary outcome of the nested pilot study is feasibility and the primary outcome of the full RCT is the Patient Activation Measu (PAM-13). The full RCT will assess the effect of the programme on online self-reported outcomes which will be assessed at baseline, after 10 weeks, and then after 20 weeks in both groups. A total sample size of N=432 participants are required based on a 2:1 randomisation. A substudy will measure physiological changes (eg, muscle mass, physical function) and patient experience (qualitative semi-structured interviews).Ethics and disseminationThis study was fully approved by the Research Ethics Committee-Leicester South on the 19 November 2020 (reference: 17/EM/0357). All participants are required to provide informed consent obtained online. The results are expected to be published in scientific journals and presented at clinical research conferences. This is protocol version 1.0 dated 27 January 2021.Trial registration numberISRCTN18314195.

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“…A range of barriers have prevented widespread implementation of comprehensive education for people with CKD and a recent systematic review of self-management interventions in CKD found many interventions lack patient engagement in their design, and the majority of interventions do not apply behavioural change theory to inform their development 7 . As such there remains a need for better and innovative self-management interventions for those with CKD 3 7 . Digital self-management interventions have the potential to improve remote disease management and health outcomes 16 and are increasingly becoming integrated into self-management to improve behaviour.…”

Section: Introductionmentioning

confidence: 99%

“…With less than 1% of time spent in contact with healthcare professionals, many patients are expected to self-manage their condition 2 . In CKD, the majority of people are managed in primary care rather than by kidney specialists 3 . Long-term CKD management requires a high level of patient engagement, both in decision-making and in the implementation of care 4 .…”

Section: Introductionmentioning

confidence: 99%

‘Self-Management Intervention through Lifestyle Education for Kidney health’ (the SMILE-K study): protocol for a single-blind longitudinal randomised control trial with nested pilot study

Lightfoot

Wilkinson

Yates

et al. 2022

Preprint

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IntroductionMany people living with chronic kidney disease (CKD) are expected to self-manage their condition. Patient activation is the term given to describe the knowledge, skills, and confidence a person has in managing their own health and is closely related to the engagement in preventive health behaviors. Self-management interventions have the potential to improve remote disease management and health outcomes. We are testing an evidence- and theory-based digital self-management structured 10-week programme developed for CKD patients called ‘My Kidneys & Me’. The primary aim of the study (SMILE-K) is to assess the effect on patient activation levels.Methods and analysisA single-blind randomised control trial (RCT) with a nested pilot study will assess the feasibility of the intervention and study design before continuation to a full RCT. Individuals aged 18 years or older, with established CKD stage 3-4 (eGFR of 15-59 ml/min/1.73m2) will be recruited through both primary and secondary care pathways. Participants will be randomised into two groups: intervention group and control group. The primary outcome is the Patient Activation Measure (PAM-13). The full RCT will assess the effect of the programme on online self-reported outcomes which will be assessed at baseline, after 10-weeks, and then after 20-weeks in both groups. A total sample size of n=432 participants are required based on a 2:1 randomisation. A sub-study will measure physiological changes (e.g., muscle mass, physical function) and patient experience (qualitative semi-structured interviews).Ethics and disseminationThis study was fully approved by the Research Ethics Committee-Leicester South on the 19/11/2020 (reference: 17/EM/0357). All participants are required to provide informed consent obtained online. The results are expected to be published in scientific journals and presented at clinical research conferences. This is protocol version 1.0 dated 27/01/2021.Trial registration numberThe study was prospectively registered as ISRCTN18314195 in December 2020.

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The National CKD Audit: a primary care condition that deserves more attention

Cited by 5 publications

References 8 publications

Estimated glomerular filtration rate equations in people of self-reported black ethnicity in the United Kingdom: Inappropriate adjustment for ethnicity may lead to reduced access to care

Estimated glomerular filtration rate equations in people of self-reported black ethnicity in the United Kingdom: Inappropriate adjustment for ethnicity may lead to reduced access to care

‘Self-Management Intervention through Lifestyle Education for Kidney health’ (the SMILE-K study): protocol for a single-blind longitudinal randomised controlled trial with nested pilot study

‘Self-Management Intervention through Lifestyle Education for Kidney health’ (the SMILE-K study): protocol for a single-blind longitudinal randomised control trial with nested pilot study

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