Cargando…
The Need for Improved Identification and Accurate Classification of Stages 3–5 Chronic Kidney Disease in Primary Care: Retrospective Cohort Study
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...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2014
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4130474/ https://www.ncbi.nlm.nih.gov/pubmed/25115813 http://dx.doi.org/10.1371/journal.pone.0100831 |
_version_ | 1782330329798803456 |
---|---|
author | Jain, Poorva Calvert, Melanie Cockwell, Paul McManus, Richard J. |
author_facet | Jain, Poorva Calvert, Melanie Cockwell, Paul McManus, Richard J. |
author_sort | Jain, Poorva |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-4130474 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-41304742014-08-14 The Need for Improved Identification and Accurate Classification of Stages 3–5 Chronic Kidney Disease in Primary Care: Retrospective Cohort Study Jain, Poorva Calvert, Melanie Cockwell, Paul McManus, Richard J. PLoS One Research Article 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. Public Library of Science 2014-08-12 /pmc/articles/PMC4130474/ /pubmed/25115813 http://dx.doi.org/10.1371/journal.pone.0100831 Text en © 2014 Jain et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Jain, Poorva Calvert, Melanie Cockwell, Paul McManus, Richard J. The Need for Improved Identification and Accurate Classification of Stages 3–5 Chronic Kidney Disease in Primary Care: Retrospective Cohort Study |
title | The Need for Improved Identification and Accurate Classification of Stages 3–5 Chronic Kidney Disease in Primary Care: Retrospective Cohort Study |
title_full | The Need for Improved Identification and Accurate Classification of Stages 3–5 Chronic Kidney Disease in Primary Care: Retrospective Cohort Study |
title_fullStr | The Need for Improved Identification and Accurate Classification of Stages 3–5 Chronic Kidney Disease in Primary Care: Retrospective Cohort Study |
title_full_unstemmed | The Need for Improved Identification and Accurate Classification of Stages 3–5 Chronic Kidney Disease in Primary Care: Retrospective Cohort Study |
title_short | The Need for Improved Identification and Accurate Classification of Stages 3–5 Chronic Kidney Disease in Primary Care: Retrospective Cohort Study |
title_sort | need for improved identification and accurate classification of stages 3–5 chronic kidney disease in primary care: retrospective cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4130474/ https://www.ncbi.nlm.nih.gov/pubmed/25115813 http://dx.doi.org/10.1371/journal.pone.0100831 |
work_keys_str_mv | AT jainpoorva theneedforimprovedidentificationandaccurateclassificationofstages35chronickidneydiseaseinprimarycareretrospectivecohortstudy AT calvertmelanie theneedforimprovedidentificationandaccurateclassificationofstages35chronickidneydiseaseinprimarycareretrospectivecohortstudy AT cockwellpaul theneedforimprovedidentificationandaccurateclassificationofstages35chronickidneydiseaseinprimarycareretrospectivecohortstudy AT mcmanusrichardj theneedforimprovedidentificationandaccurateclassificationofstages35chronickidneydiseaseinprimarycareretrospectivecohortstudy AT jainpoorva needforimprovedidentificationandaccurateclassificationofstages35chronickidneydiseaseinprimarycareretrospectivecohortstudy AT calvertmelanie needforimprovedidentificationandaccurateclassificationofstages35chronickidneydiseaseinprimarycareretrospectivecohortstudy AT cockwellpaul needforimprovedidentificationandaccurateclassificationofstages35chronickidneydiseaseinprimarycareretrospectivecohortstudy AT mcmanusrichardj needforimprovedidentificationandaccurateclassificationofstages35chronickidneydiseaseinprimarycareretrospectivecohortstudy |