Wednesday, 28 January 2009
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In 2009 the Health Survey England will for the first time contain kidney disease parameters including history of kidney disease, family history, serum creatinine for estimated Glomerular Filtration Rate (eGFR) and urinary albumin creatinine ratio. This will give us a better picture of CKD in the community than we have had previously and will increase the visibility of CKD as a public health issue.
Health Profile England is therefore intending to include kidney disease and hypertension in their next and subsequent reports.
Tuesday, 27 January 2009
- In my practice, 45-60 is the median value for this age group and 30-45 is well inside the "bell shaped curve". Could the normal values or guidelines be adjusted to take account of the normal reduction in renal function with age?
- I have a problem with the CKD codes. These are all number codes - daughter codes of 1Z1 and all at the same level. All number codes in read are codes to do with "Process of Medicine" and all disease codes start with a letter. The letter code for GU system diseases is K, and impaired renal function disorder is K08 and its daughter codes. Codes starting with the number 1 are all Symptom codes. This means that if I search for people with impaired renal function, no-one with a CKD code would be found.
- The other problem with the codes all being in the same level is that logical daughter codes do not show. By this I mean CKD 3 would naturally be subdivided into CKD 3 with proteinuria and CKD 3 without proteinuria, these latter two should be daughter codes of CKD 3 rather than on the same code level.
- I know that I have mentioned this previously but eGFR >90 does get equated to CKD 1 and eGFR 60-90 to CKD 2. Now I know that these would only normally apply in the presence of proteinuria. It seems strange therefore that there are codes for CKD1 without proteinuria (1Z18) and CKD 2 without proteinuria (1Z1A).
Dr Merlyn Wilcox, GP Partner, GP trainer and Hon Senior Lecturer in Primary Care and General Practice, South Birmingham PCT
A: Dear Merlyn, many thanks for your questions. I do appreciate that MDRD formula has limitations and is perhaps best considered as a population tool. Perhaps most important is whether or not the population being identified has increased morbidity and mortality - I think it is likely due to associated cardio-vascular disease.
I completely agree with regard to the coding. The statement "well I wouldn't start here" springs to mind. I think you are probably more familiar with the coding than I am but my understanding is also that codes beginning with 1 are "history/symptoms". Those more familiar with coding have advised that once something is in the hierarchy it is generally best left there. In CKD Stages 1 and 2, there needs to be evidence of kidney damage and while that is often signalled by a raised albumin creatinine ratio in the urine, other markers of damage can occur without proteinuria – such as ultrasound evidence of scarring from Pyelonephritis or Polycystic Kidney Disease. You may or may not know that there is a kidney group actively working on a SNOMED CT approach and I think will be a major advance.
The recent NICE guidance stating that ACR is the proteinuria test of choice and the inclusion of annual ACRs as part of the CKD section of the Quality and Outcomes Framework will soon result in many more quantitative proteinuria tests and at that stage we will be able to move towards considering the CKD population in a more dynamic way. The rate of change of eGFR for individuals is perhaps more important than the absolute value or indeed whether or not that value is in the "normal" range.
The situation is moving rapidly and your comments and observations are helpful to keep the momentum in the correct direction.
Monday, 26 January 2009
A paper outlining the details, inclusions and coding will be available shortly.
Friday, 23 January 2009
bedtime reading: supporting people with LTCs, commissioning personalised care planning - guide for commissioners
If you have a specific question, please contact the team via email firstname.lastname@example.org (stating ‘National Renal Dataset’ in the subject line) or call The IC Contact Centre, telephone 0845 300 6016 during office hours.
Wednesday, 7 January 2009
Dr Maarten Taal (Consultant Physician at Derby City General Hospital) and Nina Whitby (interactive tools lead, NHS Choices) have worked hard toward producing a new risk assessment tool based on the NICE CKD Guideline which is now available for everyone on NHS Choices.
This tool, along with the implementation of the NICE Guideline, the revision of the Quality and Outcomes Framework (to include regular urine, albumin creatinine ratio testing and the promotion of vascular checks that include a kidney disease section to be rolled out from April 2009 should help us close that gap between the recorded and predicted prevalence allowing many more people to benefit from better management of their early kidney disease.
Monday, 5 January 2009
It reports on research carried out by the Picker Institute and sets out a framework for measuring dignity. The report is available for download from the Help the Aged website: http://policy.helptheaged.org.uk/_policy/default.htm
See also http://press.helptheaged.org.uk/_press/Releases/_items/_Help+the+Aged+calls+for+compulsory+assessment+of+patient+care+and+respect.htm