Potential impact of NICE guidelines on referrals from primary care to nephrology: a primary care database and prospective research study

• DOI: 10.3399/bjgp.2022.0145
• Publication Date: 2022-09-14T18:00:14Z
• Authors: Michael K Sullivan; Bhautesh Dinesh Jani; Elaine Rutherford; Paul Welsh; Alex McConnachie; Rupert W Major; David McAllister; Dorothea Nitsch; Frances S Mair; Patrick B Mark; Jennifer S Lees
• Keywords: Albuminuria; Nephrology

Background National Institute for Health and Care Excellence 2021 guidelines on chronic kidney disease (CKD) recommend the use of Kidney Failure Risk Equation (KFRE), which includes measurement albuminuria. The equation to calculate estimated glomerular filtration rate (eGFR) has also been updated. Aim To investigate impact KFRE updated eGFR CKD diagnosis (eGFR <60 mL/min/1.73 m 2 ) in primary care potential referrals nephrology. Design setting Primary database (Secure Anonymised Information Linkage Databank [SAIL]) prospective cohort study (UK Biobank) using data available between 2013 2020. Method rates were assessed when equation. Among people with 30–59 following groups identified: those annual albuminuria testing who met nephrology referral criteria because of: a) accelerated decline or significant albuminuria; b) <30 mL/ min/1.73 only; c) >5% only. Analyses stratified by ethnicity UK Biobank. Results Using resulted a 1.2-fold fall new diagnoses predominantly White population SAIL, whereas prevalence rose 1.9-fold among Black participants Rates have consistently below 30% since 2015. In 2019, identified 182/61 721 (0.3%) patients at high risk progression before their declined 361/61 (0.6%) low-risk no longer eligible referral. Ethnic ‘Asian’ ‘other’ had disproportionately raised KFREs. Conclusion Application will lead more elevated failure (particularly minority ethnic groups) fewer patients. Albuminuria needs be expanded enable wider implementation.