GPs should refer earlier for CKD

GPs should be referring chronic kidney disease (CKD) patients to nephrologists before the disease reaches an advanced stage, according to a European Renal Association survey.

The survey of 369 European nephrologists, including 75 from the UK, revealed that nearly half UK patients, 42 per cent, are being referred to nephrologists at an advanced stage of the disease, CKD stage four or above.

Only 23 per cent of patients were referred to a nephrologist at stage one or two.

Two-thirds of UK nephrologists called for increased education and understanding of CKD in primary care, and almost all the participating nephrologists, (84 per cent), called for routine estimated glomerular filtration rate (eGFR) testing in primary care setting to improve early diagnosis and referral.

However, Dr Ian Wilkinson, a GPSI in renal medicine in Oldham. Lancashire, warned that the survey findings were alarmist.

'In the UK we have very good guidelines from the RCGP and NICE guidance on anaemia to respond to the findings of this survey,' he said.

'As long as GPs follow the guidelines in primary care then it is likely patients will be referred early enough,' he said.

GPs already check for haemoglobin levels, and routine eGFR testing is being done nationally, said Dr Wilkinson.

'There has been a lot of activity in primary care in the area of CKD care and management, but more education for GPs would be helpful, with NICE expected to release CKD guidelines in 2008/9,' he added.

East London GP Dr Penny Ackland, who has an interest in CKD, said she was surprised by the findings on early referral.

'There is a subgroup of CKD patients that need to be referred early, but there are many CKD patients that can be managed in primary care,' she said.

'There is a case for referring early if dialysis is needed. Those referred too late do less well on dialysis.'

But Dr Roger Greenwood, chairman of the UK Kidney Alliance and a consultant nephrologist in Stevenage, said the survey results showed there was still more to be done in the UK to improve quality of diagnosis and referrals by GPs.

42% of CKD patients are referred to nephrology at stage four or above.

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