Chronic kidney disease (CKD) affects approximately 1 in 20 adults and is often without symptoms until the advanced stages. For people at higher risk of CKD, such as those with diabetes and high blood pressure, NICE guidelines state that GPs should ensure they have both blood tests and urine tests annually.
The recently released National CKD audit found that on average only 54% of people with diabetes have the relevant urine tests, compared to 86% that have blood tests. In some other groups, including those with high blood pressure, it’s less than 30%.
Fiona Loud, Policy Director at the British Kidney Patient Association said “There are some really important findings from this audit – the huge variation in identifying risk of kidney disease in those with diabetes and the even greater variation in checking for CKD in those with high blood pressure. This is despite the fact that diabetes and high blood pressure are the commonest causes of kidney disease.
As patients we need primary care and rely on our doctors to look out for us; we hope that the audit will give further weight and encourage general practice to increase urine tests for those at risk.”
Further findings showed that whilst over 80% of those who have CKD had had a blood test in the previous year - only 31% had a repeat urine test. For people without diabetes, urine testing rates dropped to less than 15%. This is despite recommendations that effort should be focused on regular review. The report authors also urged GPs to review how they record the fact a patient has CKD on their systems as almost a third of confirmed CKD cases were not given the right coding and 1 in 10 people who were coded as having CKD did not have it.
The report compared GP practice results in England and Wales against NICE quality standards asking questions such as:
- Are people with risk factors being tested for CKD?
- Are people with CKD being correctly identified and given an appropriate code?
- And for people with CKD, are blood pressure targets being met, appropriate risk management being initiated, annual CKD reviews being performed and appropriate immunisations being given?
You can read the full report on the HQIP website (external link)
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