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Timeliness in chronic kidney disease and albuminuria identification: a retrospective cohort study

Timeliness in chronic kidney disease and albuminuria identification: a retrospective cohort study
Timeliness in chronic kidney disease and albuminuria identification: a retrospective cohort study

Background

Chronic kidney disease (CKD) is predominantly managed in primary care in the UK, but there is evidence of under-identification leading to lack of inclusion on practice chronic disease registers, which are necessary to ensure disease monitoring. Guidelines for CKD patients recommend urinary albumin to creatinine ratio (uACR) testing to identify albuminuria to stratify risk and guide management. This study aimed to describe the pattern and associations of timely CKD registration and uACR testing.
Methods

A retrospective cohort of individuals with incident CKD 3–5 (two estimated glomerular filtration rates (eGFR) <60 ml/min/1.73 m2???three months apart) between 2007 and 2013 was identified from a linked database containing primary and secondary care data. Descriptive statistics and Cox proportional hazards models were used to identify associations with patient characteristics of timely CKD registration and uACR testing (within a year of first low eGFR).
Results

12,988 people with CKD 3–5 were identified from 88 practices and followed for median 3.3 years. During this time period, 3235 (24.9%) were CKD-registered and 4638/12,988 (35.7%) had uACR testing (median time to CKD registration 307 days and to uACR test 379 days). 1829 (14.1%) were CKD-registered and 2229 (17.2%) had uACR testing within one year. Amongst people whose CKD was registered within a year, 676/1829 (37.0%) had uACR testing within a year (vs. 1553/11,159 (13.9%) of those not registered (p?<?0.001)). Timely uACR testing varied by year, with a sharp rise in proportion in 2009 (when uACR policy changed). Timely CKD registration was independently associated with lower eGFR, being female, earlier year of joining the cohort, having diabetes, hypertension, or cardiovascular disease but not with age. Timely uACR testing was associated with timely CKD registration, younger age, having diabetes, higher baseline eGFR and later year of joining the cohort.
Conclusions

Better systems are needed to support timely CKD identification, registration and uACR testing in primary care in order to facilitate risk stratification and appropriate clinical management.
chronic kidney disease, albuminuria, risk, general practice
1471-2296
Fraser, Simon DS
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Parkes, Julie
59dc6de3-4018-415e-bb99-13552f97e984
Culliford, David
25511573-74d3-422a-b0ee-dfe60f80df87
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Roderick, Paul J
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Fraser, Simon DS
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Parkes, Julie
59dc6de3-4018-415e-bb99-13552f97e984
Culliford, David
25511573-74d3-422a-b0ee-dfe60f80df87
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Roderick, Paul J
dbb3cd11-4c51-4844-982b-0eb30ad5085a

Fraser, Simon DS, Parkes, Julie, Culliford, David, Santer, Miriam and Roderick, Paul J (2015) Timeliness in chronic kidney disease and albuminuria identification: a retrospective cohort study. BMC Family Practice, 16 (1). (doi:10.1186/s12875-015-0235-8).

Record type: Article

Abstract


Background

Chronic kidney disease (CKD) is predominantly managed in primary care in the UK, but there is evidence of under-identification leading to lack of inclusion on practice chronic disease registers, which are necessary to ensure disease monitoring. Guidelines for CKD patients recommend urinary albumin to creatinine ratio (uACR) testing to identify albuminuria to stratify risk and guide management. This study aimed to describe the pattern and associations of timely CKD registration and uACR testing.
Methods

A retrospective cohort of individuals with incident CKD 3–5 (two estimated glomerular filtration rates (eGFR) <60 ml/min/1.73 m2???three months apart) between 2007 and 2013 was identified from a linked database containing primary and secondary care data. Descriptive statistics and Cox proportional hazards models were used to identify associations with patient characteristics of timely CKD registration and uACR testing (within a year of first low eGFR).
Results

12,988 people with CKD 3–5 were identified from 88 practices and followed for median 3.3 years. During this time period, 3235 (24.9%) were CKD-registered and 4638/12,988 (35.7%) had uACR testing (median time to CKD registration 307 days and to uACR test 379 days). 1829 (14.1%) were CKD-registered and 2229 (17.2%) had uACR testing within one year. Amongst people whose CKD was registered within a year, 676/1829 (37.0%) had uACR testing within a year (vs. 1553/11,159 (13.9%) of those not registered (p?<?0.001)). Timely uACR testing varied by year, with a sharp rise in proportion in 2009 (when uACR policy changed). Timely CKD registration was independently associated with lower eGFR, being female, earlier year of joining the cohort, having diabetes, hypertension, or cardiovascular disease but not with age. Timely uACR testing was associated with timely CKD registration, younger age, having diabetes, higher baseline eGFR and later year of joining the cohort.
Conclusions

Better systems are needed to support timely CKD identification, registration and uACR testing in primary care in order to facilitate risk stratification and appropriate clinical management.

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More information

Accepted/In Press date: 29 January 2015
Published date: 13 February 2015
Keywords: chronic kidney disease, albuminuria, risk, general practice
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 374725
URI: http://eprints.soton.ac.uk/id/eprint/374725
ISSN: 1471-2296
PURE UUID: 8be493eb-21a0-4ac0-a97c-fd0108d9238b
ORCID for Simon DS Fraser: ORCID iD orcid.org/0000-0002-4172-4406
ORCID for Julie Parkes: ORCID iD orcid.org/0000-0002-6490-395X
ORCID for David Culliford: ORCID iD orcid.org/0000-0003-1663-0253
ORCID for Miriam Santer: ORCID iD orcid.org/0000-0001-7264-5260
ORCID for Paul J Roderick: ORCID iD orcid.org/0000-0001-9475-6850

Catalogue record

Date deposited: 26 Feb 2015 17:01
Last modified: 15 Mar 2024 03:34

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Contributors

Author: Simon DS Fraser ORCID iD
Author: Julie Parkes ORCID iD
Author: David Culliford ORCID iD
Author: Miriam Santer ORCID iD
Author: Paul J Roderick ORCID iD

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