CKD quality targets labelled ‘dangerous'

GMS quality framework targets for chronic kidney disease (CKD) are ‘dangerous', a consensus group has decided.

GPs are given four quality framework points for managing hypertensive CKD patients with ACE inhibitors or angiotensin receptor blockers (ARBs).

But these drugs should only be given to patients younger than 55, according to the Royal College of Physicians of Edinburgh.

Dr Stuart Rodger, a consultant nephrologist in Glasgow, said: ‘The consensus statement said it was dangerous among the elderly in whom side-effects are more likely to occur. ACE inhibitors and ARBs should be restricted to those with proteinuria.’

Giving these patients thiazide diuretics would be in accordance with the joint guidelines on hypertension issued by NICE.

If BP is controlled, GPs should exemption report CKD patients without proteinuria from treatment with ACE inhibitors or ARBs, he added.

GPC deputy chairman Dr Laurence Buckman said: ‘If it is dangerous Dr Rodger should submit that to the renal experts who are on the quality framework committee.’

The consensus group will also apply for the quality framework to award points for carrying out a urine dipstick test for proteinuria in patients with suspected CKD.

Recommendations

  • Proteinuria tests for early CKD should be in quality framework.
  • GPs should exception report over 55s from ACE inhibitors and ARBs in certain cases.
  • CKD stages should be subdivided into stage 3A (eGFR 45–59) and 3B (eGFR 30–44).


If positive, the protein:creatinine ratio should be measured, with 100mg/mmol set as the threshold for referral.

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