Disparities in testing for renal function in UK primary care: cross-sectional study

Fam Pract. 2011 Dec;28(6):638-46. doi: 10.1093/fampra/cmr036. Epub 2011 Jun 30.

Abstract

Background: In the UK, explicit quality standards for chronic disease management, including for diabetes and chronic kidney disease (CKD), are set out National Service Frameworks and pay-for-performance indicators. These conditions are common with a prevalence of 4% and 5.4%, respectively. CKD is largely asymptomatic, detected following renal function testing and important because associated with increased mortality and morbidity, especially in people with diabetes and proteinuria.

Objectives: To investigate who has their renal function tested and any association with age, sex, ethnicity and diabetes.

Method: A cross-sectional survey in a primary care research network in south-west London (n = 220 721). The following data were extracted from routine data: age, gender, ethnicity, latest serum creatinine, diagnosis of diabetes and recording of proteinuria. We used logistic regression to explore any association in testing for CKD.

Results: People (82.1%) with diabetes had renal function and proteinuria tested; the proportion was much smaller (<0.5%) in those without. Women were more likely to have a creatinine test than men (28% versus 24%, P < 0.05), but this association was modified by age, ethnicity and presence of diabetes. People >75 years and with diabetes were most likely to have been tested. Black [adjusted odds ratio (AOR) 2.1, 95% confidence interval (CI) 2.0-2.2] and south Asian (AOR 1.65, 95% CI 1.56-1.75) patients were more likely to be tested than whites. Those where ethnicity was not stated were the only group not tested more than whites.

Conclusions: Quality improvement initiatives and equity audits, which include CKD should take account of disparities in renal function testing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • African Continental Ancestry Group / statistics & numerical data
  • Aged
  • Albuminuria / urine
  • Asian Continental Ancestry Group / statistics & numerical data
  • Creatinine / blood
  • Cross-Sectional Studies
  • Diabetes Complications / physiopathology
  • Diabetes Mellitus / physiopathology
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Kidney Function Tests / statistics & numerical data*
  • Logistic Models
  • Male
  • Middle Aged
  • Primary Health Care / statistics & numerical data*
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / diagnosis*
  • Renal Insufficiency, Chronic / physiopathology*
  • United Kingdom
  • Young Adult

Substances

  • Creatinine