Chronic kidney disease referrals from general practitioners pre- and post National Institute for Health and Care Excellence guidance 2014

ABSTRACT

Introduction

Mortality from chronic kidney disease (CKD) is increasing. Most patients die from cardiovascular disease and management of cardiovascular risks is key to prevent both mortality and progression to end-stage renal disease. In 2014, the National Institute of Health and Care Excellence (NICE) introduced guidance to help general practitioners (GPs) manage CKD patients.

Aim

We aimed to determine the impact of the updated CKD guidance on CKD/cardiovascular risks optimisation and the timeliness of referral from the primary care.

Methods

All new GP referrals to the Regional Renal Service in 2012 and 2016 were analysed. Data were collected on patient age, estimated glomerular filtration rate (eGFR) at referral, blood pressure (BP), smoking, body mass index, glycated haemoglobin (HbA1c; in diabetic patients) and lipid assessment.

Results

A total of 486 new GP referrals were received in 2012, and 574 in 2016 (18% increase post NICE CKD guideline). Post NICE, fewer stage 4 and 5 CKD patients were being referred. But late referrals (eGFR <20 mL/min/1.73 m²) were not improved. BP control had improved. More patients had cholesterol-levels checked. The number of smokers and obese patients had not improved.

Conclusion

Post NICE guidelines, GPs are better in optimising BP. Diabetes management and lifestyle modifications need further improvement.