Laboratory database population surveillance to improve detection of progressive chronic kidney disease.
BACKGROUND
Some patients with chronic kidney disease are still referred late for specialist care despite the evidence that earlier detection and intervention can halt or delay progression to end-stage kidney disease (ESKD).


OBJECTIVE
To develop a population surveillance system using existing laboratory data to enable early detection of patients at high risk of ESKD by reviewing cumulative graphs of estimated glomerular filtration rate (eGFR).


METHODS
A database was developed, updated daily with data from the laboratory computer. Cumulative eGFR graphs containing up to five years of data are reviewed by clinical scientists for all primary care patients or out-patients with a low eGFR for their age. For those with a declining trend, a report containing the eGFR graph is sent to the requesting doctor. A retrospective audit was performed using historical data to assess the predictive value of the graphs.


RESULTS
In nine months, we reported 370,000 eGFR results, reviewing 12,000 eGFR graphs. On average 60 graphs per week were flagged as 'high' or 'intermediate' risk. Patients with graphs flagged as high risk had a significantly higher mortality after 3.5 years and a significantly greater chance of requiring renal replacement therapy after 4.5 years of follow-up. Five patients (7%) with graphs flagged as high risk had a sustained >25% fall in eGFR without evidence of secondary care referral. Feedback about the service from requesting clinicians was 73% positive.


CONCLUSIONS
We have developed a system for laboratory staff to review cumulative eGFR graphs for a large population and identify patients at highest risk of developing ESKD. Further research is needed to measure the impact of this service on patient outcomes.
Department of Clinical Biochemistry, Heart of England NHS Foundation Trust, Birmingham, UK. david.kennedy@heartofengland.nhs.uk
David M
DM
Kennedy
Kamaljit
K
Chatha
Hugh C
HC
Rayner
D000368:Aged; D002984:Clinical Laboratory Information Systems; D003196:Computer Graphics; D003430:Cross-Sectional Studies; D018450:Disease Progression; D042241:Early Diagnosis; D004739:England; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011159:Population Surveillance; D058996:Quality Improvement / Q000458:organization & administration*; D012189:Retrospective Studies; D018570:Risk Assessment; D013222:State Medicine; D015996:Survival Rate
Chronic kidney disease; Estimated glomerular filtration rate; Population screening