Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

BACKGROUND: Around ten percent of the population have been reported as having Chronic Kidney Disease (CKD), which is associated with increased cardiovascular mortality. Few previous studies have ascertained the chronicity of CKD. In the UK, a payment for performance (P4P) initiative incentivizes CKD (stages 3-5) recognition and management in primary care, but the impact of this has not been assessed. METHODS AND FINDINGS: Using data from 426 primary care practices (population 2,707,130), the age standardised prevalence of stages 3-5 CKD was identified using two consecutive estimated Glomerular Filtration Rates (eGFRs) seven days apart. Additionally the accuracy of practice CKD registers and the relationship between accurate identification of CKD and the achievement of P4P indicators was determined. Between 2005 and 2009, the prevalence of stages 3-5 CKD increased from 0.3% to 3.9%. In 2009, 30,440 patients (1.1% unadjusted) fulfilled biochemical criteria for CKD but were not on a practice CKD register (uncoded CKD) and 60,705 patients (2.2% unadjusted) were included on a practice CKD register but did not fulfil biochemical criteria (miscoded CKD). For patients with confirmed CKD, inclusion in a practice register was associated with increasing age, male sex, diabetes, hypertension, cardiovascular disease and increasing CKD stage (p<0.0001). Uncoded CKD patients compared to miscoded patients were less likely to achieve performance indicators for blood pressure (OR 0.84, 95% CI 0.82-0.86 p<0.001) or recorded albumin-creatinine ratio (OR 0.73, 0.70-0.76, p<0.001). CONCLUSIONS: The prevalence of stages 3-5 CKD, using two laboratory reported eGFRs, was lower than estimates from previous studies. Clinically significant discrepancies were identified between biochemically defined CKD and appearance on practice registers, with misclassification associated with sub-optimal care for some people with CKD.

Original publication

DOI

10.1371/journal.pone.0100831

Type

Journal article

Journal

PLoS One

Publication Date

2014

Volume

9

Keywords

Adult, Aged, Aged, 80 and over, Cohort Studies, Creatinine, Disease Management, Female, Glomerular Filtration Rate, Health Services Needs and Demand, Humans, Male, Middle Aged, Prevalence, Primary Health Care, Quality Improvement, Registries, Renal Insufficiency, Chronic, Retrospective Studies, Risk Factors, United Kingdom, Young Adult