Like many of my colleagues, I am concerned about the new chronic kidney disease (CKD) clinical domain.
Undoubtedly, strict control of hypertension, dyslipidaemia and diabetes will slow down progressive kidney decline.
However, the sole criterion in the quality and outcomes framework is the estimated eGFR.
An eGFR of 59 or less will automatically include the patient in the register of patients with CKD stage 3-5.
We will lose points if that patient is not on an ACE inhibitor or ARB and their BP is not (lt/et)140/85.
This is clinically sound in younger patients, but it appears that the eGFR is accurate only up to the age of 70 years.
I have found over the past few months numerous eGFRs of 59 or less in the older population, many of whom have well-controlled BP or diabetes.
I have a problem putting a lot of these older people on ACE/ARB drugs or driving their BPs even lower.
Surely there must be some sort of clarification in these older people, or do we conclude that 70 years and over is an unsuitable age owing to the inaccuracy of the eGFR?
Dr James Kenny, Ahoghill, County Antrim.