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

被引：13

作者：

Sullivan, Michael K. ^{[1
]}

Jani, Bhautesh Dinesh ^{[2
]}

Rutherford, Elaine ^{[1
,3
]}

Welsh, Paul ^{[1
]}

McConnachie, Alex ^{[4
]}

Major, Rupert W. ^{[5
,6
]}

McAllister, David ^{[7
]}

Nitsch, Dorothea ^{[8
]}

Mair, Frances S. ^{[2
]}

Mark, Patrick B. ^{[1
]}

Lees, Jennifer S. ^{[1
]}

机构：

[1] Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow, Lanark, Scotland

[2] Univ Glasgow, Inst Hlth & Wellbeing, Gen Practice & Primary Care, Glasgow, Lanark, Scotland

[3] NHS Dumfries & Galloway, Mountainhall Treatment Ctr, Renal Unit, Dumfries, Scotland

[4] Univ Glasgow, Robertson Ctr Biostat, Inst Hlth & Wellbeing, Clin Trial Biostat, Glasgow, Lanark, Scotland

[5] Univ Leicester, Dept Cardiovasc Sci, Leicester, Leics, England

[6] Univ Hosp Leicester, John Walls Renal Unit, Leicester, Leics, England

[7] Univ Glasgow, Inst Hlth & Wellbeing, Publ Hlth, Clin Epidemiol & Med Informat, Glasgow, Lanark, Scotland

[8] London Sch Hyg & Trop Med, Fac Epidemiol & Populat Hlth, Clin Epidemiol, London, England

来源：

BRITISH JOURNAL OF GENERAL PRACTICE | 2023年 / 73卷 / 727期

基金：

英国医学研究理事会;

关键词：

diagnosis; general practice; guidelines; hospital referrals; largedatabase research; renal medicine; CHRONIC KIDNEY-DISEASE; RENAL-DISEASE; MANAGEMENT; OUTCOMES; RISK;

D O I：

10.3399/BJGP.2022.0145

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

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 m(2)) in primary careand potential referrals to nephrology. Design and setting Primarycare 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 30-59mL/min/1.73 m(2) 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 m(2) only; and c) KFRE >5% only. Analyses were stratified by ethnicity in UK Biobank. Results Using the updated eGFR equation resulted in a 1.2-fold fall in new CKD diagnoses in the predominantly White population in SAIL,whereas CKD prevalence rose by 1.9-fold among Black participants in UK Biobank. Rates of albuminuria testing have been consistently below 30% since 2015. In 2019,using KFRE > 5% 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.

引用

页码：E141 / E147

页数：7

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