QOF kidney disease definition 'overdiagnoses patients'

The definition of chronic kidney disease (CKD) used in the QOF may be overdiagnosing thousands of patients and leading to unnecessary treatment, experts have argued.

Criteria for diagnosing kidney disease may cause unnecessary treatment (Photo: PhotoDisc)
Criteria for diagnosing kidney disease may cause unnecessary treatment (Photo: PhotoDisc)

An internationally adopted definition of CKD, which is used in NICE guidelines and the QOF, identifies one in eight adults in the US as having the disease, according to researchers in Australia.

Yet, studies suggest few patients with moderate disease go on to develop serious illness.

This may be prompting unnecessary and potentially harmful treatment of patients and adding to healthcare costs, the researchers argued in a BMJ analysis.

They called for a review of the current definition, and urged clinicians to be cautious about labelling patients with the disease.

A new framework for defining CKD was introduced in 2002 by the US National Kidney Foundation. This has been amended over the years, most recently in 2012.

NICE uses this framework to define CKD in the QOF. Targets require GPs to hold a register of patients with stage three to five CKD and to keep BP under tight control.

It was hoped that a standardised definition would lead to earlier detection and treatment to slow progression to more serious disease.

However, Ray Moynihan from Bond University in Australia and colleagues said this definition identifies one in eight US adults (14%) as having the disease.

Research has shown less than 1% of people with moderate CKD (stage 3A disease; eGFR 45-59ml/min/1.73m2) under this definition go on to develop end-stage renal disease after eight years.

This suggests thousands of people with moderate CKD may be treated to prevent one case of end-stage disease, the authors said.

Caution urged
A study by the University of Cardiff found specialist referrals for CKD had risen 60% in a single trust covering a population of 560,000 people after the CKD QOF targets were introduced.

The authors said: 'The benefits, harms, and costs of testing, monitoring, and treating the increased number of people being identified as having CKD need to be established by prospective studies.

'Meanwhile, the risk of overdiagnosis warrants greater professional scrutiny and more public awareness.'

They added: 'Clinicians should be careful not to apply disease labels to the many older people whose eGFR falls within the definition of CKD but who are at very low risk of developing clinical problems.'

They concluded: 'It is in everyone’s interest to find the best way to maximise prevention of kidney disease and its consequences while minimising the risks and costs of overdiagnosis.'

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