Potential impact of NICE guidelines on referrals from primary care to nephrology: a primary care database and prospective research study

Sullivan, M. K. et al. (2023) Potential impact of NICE guidelines on referrals from primary care to nephrology: a primary care database and prospective research study. British Journal of General Practice, 73(727), e141-e147. (doi: 10.3399/BJGP.2022.0145) (PMID:36376072) (PMCID:PMC9678375)

Abstract

Background: NICE 2021 guidelines on chronic kidney disease (CKD) recommend the use of the Kidney Failure Risk Equation (KFRE), which includes measurement of albuminuria. The equation to calculate estimated glomerular filtration rate (eGFR) has also been updated. Aim: To investigate the impact of KFRE and the updated eGFR equation on CKD diagnosis (eGFR<60mL/min/1.73m2) in primary care and potential referrals to nephrology. Design/setting: Primary care database (SAIL) and prospective cohort study (UK Biobank). Method: CKD diagnosis rates were assessed when using the updated eGFR equation. Amongst people with eGFR 30-59mL/min/1.73m2, we identified those with albuminuria testing and those who met nephrology referral criteria by: A)Accelerated eGFR decline or significant albuminuria B)eGFR decline <30mL/min/1.73m2 only and C) KFRE>5% only. Analyses were stratified by ethnicity in UK Biobank. Results: Using the updated eGFR equation resulted in a 1.2-fold fall in new CKD diagnoses in the predominantly white population in SAIL, whereas CKD prevalence rose by 1.9-fold amongst black participants in UK Biobank. Rates of albuminuria testing have been consistently below 30% since 2015. In 2019, using KFRE>5% identified 182/61,721 (0.3%) patients at high risk of CKD progression before their eGFR declined and 361 (0.6%) low-risk patients who were no longer eligible for referral. Asian and “other” ethnic groups had disproportionately raised KFREs. Conclusion: Application of KFRE criteria in primary care will lead to referral of more patients at elevated risk of kidney failure (particularly amongst minority ethnic groups) and fewer low-risk patients. Albuminuria testing needs to be expanded to enable wider KFRE implementation.

• Item Type: Articles
• Additional Information: This work was supported by the Medical Research Council (Grant number MR/V001671/1 to MKS) and the Chief Scientist Office (Scotland: Grant number PCL/20/10 to JSL and PCL/18/03 to ER).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McConnachie, Professor Alex and Jani, Dr Bhautesh and Mark, Professor Patrick and Sullivan, Dr Michael and Lees, Jennifer and Welsh, Professor Paul and McAllister, Professor David and Rutherford, Dr Elaine and Mair, Professor Frances
• Authors: Sullivan, M. K., Jani, B. D., Rutherford, E., Welsh, P., McConnachie, A., Major, R. W., McAllister, D., Nitsch, D., Mair, F. S., Mark, P. B., and Lees, J. S.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: British Journal of General Practice
• Publisher: Royal College of General Practitioners
• ISSN: 0960-1643
• ISSN (Online): 1478-5242
• Published Online: 14 September 2022
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in British Journal of General Practice 73(727): e141-e147
• Publisher Policy: Reproduced under a Creative Commons License

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Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
309978		Tackling the challenge of multimorbidity in chronic kidney disease	Michael Sullivan	Medical Research Council (MRC)	MR/V001671/1	CAMS - Cardiovascular Science