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Association between practice coding of chronic kidney disease (CKD) in primary care and subsequent hospitalisations and death: a cohort analysis using national audit data

OBJECTIVE: To examine the association between practice percentage coding of chronic kidney disease (CKD) in primary care with risk of subsequent hospitalisations and death. DESIGN: Retrospective cohort study using linked electronic healthcare records. SETTING: 637 general practitioner (GP) practices...

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Autores principales: Cleary, Faye, Kim, Lois, Prieto-Merino, David, Wheeler, David, Steenkamp, Retha, Fluck, Richard, Adlam, David, Denaxas, Spiros, Griffith, Kathryn, Loud, Fiona, Hull, Sally, Caplin, Ben, Nitsch, Dorothea
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9558803/
https://www.ncbi.nlm.nih.gov/pubmed/36220323
http://dx.doi.org/10.1136/bmjopen-2022-064513
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author Cleary, Faye
Kim, Lois
Prieto-Merino, David
Wheeler, David
Steenkamp, Retha
Fluck, Richard
Adlam, David
Denaxas, Spiros
Griffith, Kathryn
Loud, Fiona
Hull, Sally
Caplin, Ben
Nitsch, Dorothea
author_facet Cleary, Faye
Kim, Lois
Prieto-Merino, David
Wheeler, David
Steenkamp, Retha
Fluck, Richard
Adlam, David
Denaxas, Spiros
Griffith, Kathryn
Loud, Fiona
Hull, Sally
Caplin, Ben
Nitsch, Dorothea
author_sort Cleary, Faye
collection PubMed
description OBJECTIVE: To examine the association between practice percentage coding of chronic kidney disease (CKD) in primary care with risk of subsequent hospitalisations and death. DESIGN: Retrospective cohort study using linked electronic healthcare records. SETTING: 637 general practitioner (GP) practices in England. PARTICIPANTS: 167 208 patients with CKD stages 3–5 identified by 2 measures of estimated glomerular filtration rate <60 mL/min/1.73 m(2), separated by at least 90 days, excluding those with coded initiation of renal replacement therapy. MAIN OUTCOME MEASURES: Hospitalisations with cardiovascular (CV) events, heart failure (HF), acute kidney injury (AKI) and all-cause mortality RESULTS: Participants were followed for (median) 3.8 years for hospital outcomes and 4.3 years for deaths. Rates of hospitalisations with CV events and HF were lower in practices with higher percentage CKD coding. Trends of a small reduction in AKI but no substantial change in rate of deaths were also observed as CKD coding increased. Compared with patients in the median performing practice (74% coded), patients in practices coding 55% of CKD cases had a higher rate of CV hospitalisations (HR 1.061 (95% CI 1.015 to 1.109)) and HF hospitalisations (HR 1.097 (95% CI 1.013 to 1.187)) and patients in practices coding 88% of CKD cases had a reduced rate of CV hospitalisations (HR 0.957 (95% CI 0.920 to 0.996)) and HF hospitalisations (HR 0.918 (95% CI 0.855 to 0.985)). We estimate that 9.0% of CV hospitalisations and 16.0% of HF hospitalisations could be prevented by improving practice CKD coding from 55% to 88%. Prescription of antihypertensives was the most dominant predictor of a reduction in hospitalisation rates for patients with CKD, followed by albuminuria testing and use of statins. CONCLUSIONS: Higher levels of CKD coding by GP practices were associated with lower rates of CV and HF events, which may be driven by increased use of antihypertensives and regular albuminuria testing, although residual confounding cannot be ruled out.
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spelling pubmed-95588032022-10-14 Association between practice coding of chronic kidney disease (CKD) in primary care and subsequent hospitalisations and death: a cohort analysis using national audit data Cleary, Faye Kim, Lois Prieto-Merino, David Wheeler, David Steenkamp, Retha Fluck, Richard Adlam, David Denaxas, Spiros Griffith, Kathryn Loud, Fiona Hull, Sally Caplin, Ben Nitsch, Dorothea BMJ Open Renal Medicine OBJECTIVE: To examine the association between practice percentage coding of chronic kidney disease (CKD) in primary care with risk of subsequent hospitalisations and death. DESIGN: Retrospective cohort study using linked electronic healthcare records. SETTING: 637 general practitioner (GP) practices in England. PARTICIPANTS: 167 208 patients with CKD stages 3–5 identified by 2 measures of estimated glomerular filtration rate <60 mL/min/1.73 m(2), separated by at least 90 days, excluding those with coded initiation of renal replacement therapy. MAIN OUTCOME MEASURES: Hospitalisations with cardiovascular (CV) events, heart failure (HF), acute kidney injury (AKI) and all-cause mortality RESULTS: Participants were followed for (median) 3.8 years for hospital outcomes and 4.3 years for deaths. Rates of hospitalisations with CV events and HF were lower in practices with higher percentage CKD coding. Trends of a small reduction in AKI but no substantial change in rate of deaths were also observed as CKD coding increased. Compared with patients in the median performing practice (74% coded), patients in practices coding 55% of CKD cases had a higher rate of CV hospitalisations (HR 1.061 (95% CI 1.015 to 1.109)) and HF hospitalisations (HR 1.097 (95% CI 1.013 to 1.187)) and patients in practices coding 88% of CKD cases had a reduced rate of CV hospitalisations (HR 0.957 (95% CI 0.920 to 0.996)) and HF hospitalisations (HR 0.918 (95% CI 0.855 to 0.985)). We estimate that 9.0% of CV hospitalisations and 16.0% of HF hospitalisations could be prevented by improving practice CKD coding from 55% to 88%. Prescription of antihypertensives was the most dominant predictor of a reduction in hospitalisation rates for patients with CKD, followed by albuminuria testing and use of statins. CONCLUSIONS: Higher levels of CKD coding by GP practices were associated with lower rates of CV and HF events, which may be driven by increased use of antihypertensives and regular albuminuria testing, although residual confounding cannot be ruled out. BMJ Publishing Group 2022-10-11 /pmc/articles/PMC9558803/ /pubmed/36220323 http://dx.doi.org/10.1136/bmjopen-2022-064513 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Renal Medicine
Cleary, Faye
Kim, Lois
Prieto-Merino, David
Wheeler, David
Steenkamp, Retha
Fluck, Richard
Adlam, David
Denaxas, Spiros
Griffith, Kathryn
Loud, Fiona
Hull, Sally
Caplin, Ben
Nitsch, Dorothea
Association between practice coding of chronic kidney disease (CKD) in primary care and subsequent hospitalisations and death: a cohort analysis using national audit data
title Association between practice coding of chronic kidney disease (CKD) in primary care and subsequent hospitalisations and death: a cohort analysis using national audit data
title_full Association between practice coding of chronic kidney disease (CKD) in primary care and subsequent hospitalisations and death: a cohort analysis using national audit data
title_fullStr Association between practice coding of chronic kidney disease (CKD) in primary care and subsequent hospitalisations and death: a cohort analysis using national audit data
title_full_unstemmed Association between practice coding of chronic kidney disease (CKD) in primary care and subsequent hospitalisations and death: a cohort analysis using national audit data
title_short Association between practice coding of chronic kidney disease (CKD) in primary care and subsequent hospitalisations and death: a cohort analysis using national audit data
title_sort association between practice coding of chronic kidney disease (ckd) in primary care and subsequent hospitalisations and death: a cohort analysis using national audit data
topic Renal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9558803/
https://www.ncbi.nlm.nih.gov/pubmed/36220323
http://dx.doi.org/10.1136/bmjopen-2022-064513
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