GPs to be given tougher quality targets for CKD

GP workload for chronic kidney disease (CKD) is set to expand. Targets for measuring the rate of change of estimated glomerular filtration rate (eGFR), proteinuria and anaemia are all likely, says a GP who helped draw up the quality indicators.

Dr Simon de Lusignan, a GP and expert in biomedical informatics at St George’s Hospital in London, said CKD indicators introduced into the quality framework in 2006 were developed to ‘ease GPs into this’.

‘It was deliberately done to create a manageable start,’ he said.

While eGFR is considered better than creatinine at detecting patients with CKD, monitoring how eGFR changes is a better indicator of which patients have declining renal function.

‘I think we’ll be more interested in rate of change, but this is three to five years away,’ said Dr de Lusignan.

Checking for proteinuria, as recommended in the UK CKD consensus statement last month, is also likely to be encompassed in the quality framework, as is testing for anaemia in CKD, he said.

London GP Dr Penny Ackland, who helped draw up the NICE guidelines on anaemia management in CKD, backed all of the recommendations.

‘There are a lot of people with an eGFR in the range of 30–60ml/min/1.73m2 who do not progress over 30 years,’ she said. ‘They don’t want referral.’

Dr de Lusignan presented plans for research into how primary care could improve CKD outcomes at a joint meeting of the DoH and Kidney Research UK, which was held in London last week.

The project will be launched at four locations in April and will use GP computer records to see if patient empowerment schemes, audit-based education for GPs or CKD clinics improve outcomes.

DoH renal czar Dr Donal O’Donoghue, who was one of the speakers at the event, said GPs had to move on from the initial furore that surrounded the inclusion of CKD in the quality framework.

‘We’ve had the stormy year last year and now we’ve got to get on with the job of managing kidney disease,’ he said.

Part of this would be to look after CKD alongside other vascular conditions.

‘There is a push in the DoH to bring vascular diseases together,’ explained Dr O’Donoghue. ‘It’s not as joined up as it needs to be.’

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