The impact of population-based identification of chronic kidney disease using estimated glomerular filtration rate (eGFR) reporting

Nephrol Dial Transplant. 2008 Feb;23(2):556-61. doi: 10.1093/ndt/gfm839. Epub 2007 Dec 8.

Abstract

Background: The object of this study was to determine the impact of estimated glomerular filtration rate (eGFR) reporting, as part of a disease management programme (DMP), and clarify the prevalence of chronic kidney disease (CKD) and the level of un-met need in a UK Primary Care Trust.

Methods: Our approach was to prospectively identify patients with an eGFR <60 ml/min/1.73 m(2) using the four-variable MDRD equation in all patients from West Lincolnshire PCT (population 185 434 over the age of 15 years) having a routine estimation of serum creatinine.

Results: During the first 12 months of the programme 25.4% of the population had an eGFR reported. The likelihood of having an eGFR reported increased markedly with age. The prevalence of CKD stages 3-5 within primary care was 7.3%. Only 3.7% of patients with CKD stages 3-5 were under nephrology care compared to 13.7% in non-nephrology secondary care and 82.6% in primary care. There were marked differences in the male to female ratio between primary care and nephrology care, 1:1.9 versus 0.6:1, respectively (P < 0.001). The incidence of newly identified patients with CKD stages 4 and 5 was 0.16%. Initially there was a marked (up to 7-fold month on month) rise in nephrology referrals following institution of eGFR reporting which was reversed by the introduction of a referral management service as part of the DMP. Only 33% of patients with CKD stage 4 or 5, identified from within primary care, went on to have a nephrology referral in the subsequent 12 months compared with 44% and 78% respectively identified from non-nephrology secondary care (P < 0.001).

Conclusions: The reporting of the eGFR in association with this DMP effectively identified patients with CKD. A referral assessment programme can effectively ensure appropriate nephrology referral and avoids exceeding the capacity of nephrology services. The vast majority of patients with CKD stages 3-5 are cared for within primary care. There are marked gender differences in the prevalence of CKD stages 3-5 that are not reflected by referral patterns to nephrology services. There are significant differences in referral practices between primary and secondary care. In a steady state the burden of incident patients with CKD stages 4-5 should not exceed the capacity of the local nephrology service.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Chronic Disease
  • Female
  • Glomerular Filtration Rate*
  • Humans
  • Kidney Diseases / blood
  • Kidney Diseases / diagnosis*
  • Male
  • Middle Aged
  • Referral and Consultation / statistics & numerical data
  • United Kingdom