Identifying patients with chronic kidney disease from general practice computer records.
BACKGROUND
Chronic kidney disease (CKD) is an important predictor of end-stage renal disease, as well as a marker of increased mortality. The New Opportunities for Early Renal Intervention by Computerised Assessment (NEOERICA) project aimed to assess whether people with undiagnosed CKD who might benefit from early intervention could be identified from GP computer records.


METHODS
The simplified Modification of Diet in Renal Disease (MDRD) equation was used to estimate glomerular filtration rate (GFR) and determine stage of CKD in patients from 12 practices in Surrey, Kent and Greater Manchester with SCr recorded in their notes. Further data were extracted on associated co-morbidities and potentially modifiable risk factors.


RESULTS
One quarter (25.7%; 28,862/112,215) had an SCr recorded and one in five (18.9%) of them had a GFR <60 ml/min/1.73 m2 (equivalent to Stage 3-5 CKD), representing 4.9% of the population. Only 3.6% of these were recorded as having renal disease. Three-quarters (74.6%; 4075/5449) of those with Stage 3-5 CKD had one or more circulatory diseases; 346 were prescribed potentially nephrotoxic drugs and over 4000 prescriptions were issued for drugs recommended to be used with caution in renal impairment.


CONCLUSIONS
Patients with CKD can be identified by searching GP computer databases; along with associated co-morbidities and treatment. Results revealed a similar rate of Stage 3-5 CKD to that found previously in the USA. The very low rate of recording of renal disease in patients found to have CKD indicates scope for improving detection and early intervention.
de Lusignan
Simon
S
Primary Care Informatics, Department of Community Health Sciences, Hunter Wing, St George's Hospital Medical School, London SW17 0RE. slusigna@sghms.ac.uk
Chan
Tom
T
Stevens
Paul
P
O'Donoghue
Donal
D
Hague
Nigel
N
Dzregah
Billy
B
Van Vlymen
Jeremy
J
Walker
Mel
M
Hilton
Sean
S
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D004739:England / Q000453:epidemiology; D005194:Family Practice / Q000458:organization & administration* / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution