Exclusive - Czar warns on Framingham failure to spot CKD

DoH renal czar Dr Donal O'Donaghue says QRISK2 is the preferred option for assessing vascular risk.

CKD is under-diagnosed but presents an increased risk of CVD
CKD is under-diagnosed but presents an increased risk of CVD

Practices that use the Framingham risk tool for their health checks could be failing to identify patients with chronic kidney disease (CKD), the renal czar has warned.

DoH guidance currently states that practices can decide whether they wish to use Framingham or QRISK2 for health checks, despite increasing calls to ditch the out-of-date Framingham tool.

Speaking at the Primary Care Live conference in London last week, DoH director of kidney services Dr Donal O'Donoghue acknowledged that the Framingham risk tool would miss cases of CKD.

Dr O'Donoghue told GP: 'Kidney disease is not unfortunately in the risk engines, but I think it should be, given the link shown in the epidemiological studies.

'Framingham changed the world but as time marches on more local and more detailed assessments are likely to better predict vascular risk, such as QRISK.'

Now that CKD is visible, risk assessment groups will be looking at how CKD can both be predicted and how it can play into the risk engines, said Dr O'Donoghue.

He added that it was vital for GPs to check for CKD in patients at health checks because of the increased risk of vascular events associated with the disease.

'At every stage of CKD, there is an increased risk of vascular disease. CKD is part of the cardiovascular disease jigsaw; it should not be considered as separate.

'I do hope GPs know that health checks are about kidney disease as much as other vascular diseases. We need to detect patients early to help reduce the costs of treatment and dialysis for CKD,' he said.

Some PCTs are discussing adding a urine test so the CKD assessment is more complete, which may be appropriate in places with high CKD rates, added Dr O'Donoghue.

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