Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Feb 13:16:18.
doi: 10.1186/s12875-015-0235-8.

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

Simon D S Fraser  1 , Julie Parkes  2 , David Culliford  3 , Miriam Santer  4 , Paul J Roderick  5
Affiliations

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

Simon D S Fraser et al. BMC Fam Pract. .

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 m(2) ≥ 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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Procedures leading to CKD registration. Key: Green boxes indicate clinician actions, blue boxes indicate diagnostic points.
Figure 2
Figure 2
Flow chart of study population identification in the Hampshire Health Record (HHR).
Figure 3
Figure 3
Proportion of people with uACR and uPCR testing within a year by year of joining the cohort.
See this image and copyright information in PMC

References

    1. Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010;375(9731):2073–81. doi: 10.1016/S0140-6736(10)60674-5. - DOI - PMC - PubMed
    1. Nitsch D, Grams M, Sang Y, Black C, Cirillo M, Djurdjev O, et al. Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis. BMJ. 2013;346:f324. doi: 10.1136/bmj.f324. - DOI - PMC - PubMed
    1. Gansevoort RT, Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, et al. Lower estimated GFR and higher albuminuria are associated with adverse kidney outcomes. A collaborative meta-analysis of general and high-risk population cohorts. Kidney Int. 2011;80(1):93–104. doi: 10.1038/ki.2010.531. - DOI - PMC - PubMed
    1. Arnlöv J, Evans JC, Meigs JB, Wang TJ, Fox CS, Levy D, et al. Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals - The Framingham heart study. Circulation. 2005;112(7):969–75. doi: 10.1161/CIRCULATIONAHA.105.538132. - DOI - PubMed
    1. Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA. 2001;286(4):421–6. doi: 10.1001/jama.286.4.421. - DOI - PubMed

Publication types