CKD prevalence is less than half of true figure

The level of chronic kidney disease CKD recorded by practices in England for 2006/7 is likely to under-represent the true level of disease by more than 50 per cent.

Data obtained by GP from the quality management and analysis system (QMAS), which generates quality pay, show CKD prevalence in England of around 2.2 per cent.

But experts say the true level of CKD in the UK is likely to be close to 5 per cent.

Obesity prevalence, reported as 7.1 per cent on QMAS, is also lower than expected. However, prevalence of 1.3 per cent reported for AF is close to predicted levels.

Data for these conditions was collected through the quality framework for the first time in 2006/7. All of the QMAS figures are measured against the entire population, rather than specific age groups.

South London GP Dr Penny Ackland, who helped draw up NICE guidance on management of anaemia in CKD, said research showed the combined rate of stage three, four and five CKD in the US was 4.7 per cent. These are the stages measured under the quality framework.

The US data, from the Third National Health and Nutrition Survey, was based on eGFR measurements, which are also the basis for quality framework data.

‘No large study has been performed in the UK, but similar figures, of 4.9 per cent for stages three to five, have come from UK practices, suggesting that translation to the UK population is accurate,’ Dr Ackland said.

The rate of CKD is thought to be rising, she added. Dr Ackland said low levels reported on QMAS reflected the fact that many practices had no access to eGFR tests until well after CKD targets took effect.

West London GP Dr Sarah Jarvis, a member of the Primary Care Cardiovascular Society, said CKD statistics were low because only patients with stage-four and five CKD would have been diagnosed prior to use of eGFR testing. Around 80 per cent of patients with stage-three, four or five CKD are in the stage-three category.

Dr Jarvis and Dr Ackland predicted the quality framework would show around 5 per cent CKD prevalence within the next two years.

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