New chronic kidney disease audit published

December 15, 2017

Sustainability and Transformation Partnerships, Clinical Commissioning Groups and primary care practices must all work together to improve outcomes for patients with Chronic Kidney Disease (CKD), according to the national Chronic Kidney Disease Audit published today. Recommendations include reviewing practice procedures and monitoring performance to help identify and actively manage patients with CKD.

CKD is a long-term irreversible deterioration in the function of the kidneys, usually found in older patients or those with diabetes and high blood pressure. CKD is often without symptoms until it progresses to the very advanced stages and is detected through blood and urine tests. Advanced CKD (stages 3-5) affects 5.5% of adults in England and Wales.

When detected, it is recommended that CKD is recorded in electronic patient records using Read codes; these allow patients to be effectively monitored and allow the safer prescribing of drugs. Compared to patients with reduced kidney function who do not have a Read code, those with a read code are known to receive more comprehensive management (such as blood pressure therapy and statin prescription).

The audit reviewed how the coding of CKD patients in primary care improved patient outcomes; it looked at the data of patients with advanced CKD (stages 3-5) from a sample of 1,005 primary care practices across England and Wales. The sample accounted for 10% of practices in England and 75% in Wales. From a total of more than 400,000 patients with kidney disease, there was a total of more than 250,000 years of follow-up.

Patients with advanced CKD who had a CKD Read code were found to be half as likely to be admitted to hospital in an emergency, and six time less likely to suffer a sudden worsening of their kidney function (acute kidney injury or AKI), when taking into account their age, gender, kidney function, and the presence of other relevant medical conditions (diabetes, hypertension, cardiovascular disease). In similar analyses, death rates were approximately twice as high among people with advanced CKD who had not been coded compared to those who had.

The audit found there were wide variations in the coding of CKD patients in the primary care practices reviewed.

A key recommendation of the report is that when patients with CKD are identified and coded in primary care they should be reviewed regularly for management of high blood pressure, including being prescribed cholesterol lowering treatments. In more severe cases, advice on preventative flu and pneumococcal vaccination should be given.

Audit co-author Dr Dorothea Nitsch, Professor in Clinical Epidemiology at the London School of Hygiene & Tropical Medicine, said:

"Each year, for every 100 patients with CKD and moderate to severe kidney function impairment there are 38 unplanned hospital admissions, two admissions to intensive care and seven deaths. Detecting and subsequently Read coding CKD in primary care is crucial to enable systematic management of these patients with regards to their blood pressure, statin medication, and vaccination. Together these measures can improve patient outcomes.

"Primary care practices should review their processes to improve the identification and care of people with CKD. Clinical commissioning groups should put in place quality improvement tools and incentives to support identification and regular clinical review of CKD patients."

Professor David Wheeler, UCL Centre for Nephrology Royal Free Hospital and Chair of the Clinical Reference Group of the Audit, said:

"This report raises the possibility that improved identification and management of patients with CKD in primary care might reduce unplanned admissions to hospital."

The National CKD Audit was commissioned by the Healthcare Quality Improvement Partnership (HQIP) and conducted by the Informatica Systems, the London School of Hygiene & Tropical Medicine, UCL (University College London) and Queen Mary University of London.

The sample used in this audit was broadly representative of England and Wales in terms of age and sex, although though those of White ethnicity and living in rural areas are overrepresented.

The authors note that further research is needed to establish whether it is the use of CKD Read codes (and the care processes that follow from this) that lead to the reduced rates of hospital admissions and death or whether the effect is explained by other characteristics of those patients that have not been coded.
-end-
For more information or to request interviews please contact James Barr, Media Manager at the London School of Hygiene & Tropical Medicine on press@lshtm.ac.uk or +44(0)207 9272802.

Notes to Editors

Report available at https://www.lshtm.ac.uk/ckdaudit#the-audit

About the London School of Hygiene & Tropical Medicine

The London School of Hygiene & Tropical Medicine is a world-leading centre for research and postgraduate education in public and global health, with more than 4,000 students and 1,000 staff working in over 100 countries. The School is one of the highest-rated research institutions in the UK, is among the world's leading schools in public and global health, and was named University of the Year in the Times Higher Education Awards 2016. Our mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice. http://www.lshtm.ac.uk

About UCL (University College London)

UCL was founded in 1826. We were the first English university established after Oxford and Cambridge, the first to open up university education to those previously excluded from it, and the first to provide systematic teaching of law, architecture and medicine. We are among the world's top universities, as reflected by performance in a range of international rankings and tables. UCL currently has over 39,000 students from 150 countries and over 12,500 staff. Our annual income is more than £1 billion. http://www.ucl.ac.uk | Follow us on Twitter @uclnews | Watch our YouTube channel YouTube.com/UCLTV

London School of Hygiene & Tropical Medicine

Related Blood Pressure Articles from Brightsurf:

Children who take steroids at increased risk for diabetes, high blood pressure, blood clots
Children who take oral steroids to treat asthma or autoimmune diseases have an increased risk of diabetes, high blood pressure, and blood clots, according to Rutgers researchers.

High blood pressure treatment linked to less risk for drop in blood pressure upon standing
Treatment to lower blood pressure did not increase and may decrease the risk of extreme drops in blood pressure upon standing from a sitting position.

Changes in blood pressure control over 2 decades among US adults with high blood pressure
National survey data were used to examine how blood pressure control changed overall among U.S. adults with high blood pressure between 1999-2000 and 2017-2018 and by age, race, insurance type and access to health care.

Transient increase in blood pressure promotes some blood vessel growth
Blood vessels are the body's transportation system, carrying oxygen and nutrients to cells and whisking away waste.

Effect of reducing blood pressure medications on blood pressure control in older adults
Whether the amount of blood pressure medications taken by older adults could be reduced safely and without a significant change in short-term blood pressure control was the objective of this randomized clinical trial that included 534 adults 80 and older.

Brain blood flow sensor discovery could aid treatments for high blood pressure & dementia
A study led by researchers at UCL has discovered the mechanism that allows the brain to monitor its own blood supply, a finding in rats which may help to find new treatments for human conditions including hypertension (high blood pressure) and dementia.

Here's something that will raise your blood pressure
The apelin receptor (APJ) has been presumed to play an important role in the contraction of blood vessels involved in blood pressure regulation.

New strategy for treating high blood pressure
The key to treating blood pressure might lie in people who are 'resistant' to developing high blood pressure even when they eat high salt diets, shows new research published today in Experimental Physiology.

Arm cuff blood pressure measurements may fall short for predicting heart disease risk in some people with resistant high blood pressure
A measurement of central blood pressure in people with difficult-to-treat high blood pressure could help reduce risk of heart disease better than traditional arm cuff readings for some patients, according to preliminary research presented at the American Heart Association's Hypertension 2019 Scientific Sessions.

Heating pads may lower blood pressure in people with high blood pressure when lying down
In people with supine hypertension due to autonomic failure, a condition that increases blood pressure when lying down, overnight heat therapy significantly decreased systolic blood pressure compared to a placebo.

Read More: Blood Pressure News and Blood Pressure Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.