Family Practice Advance Access originally published online on April 6, 2005
Family Practice 2005 22(3):234-241; doi:10.1093/fampra/cmi026
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Identifying patients with chronic kidney disease from general practice computer records
a Primary Care Informatics, Department of Community Health Sciences, Hunter Wing, St George's Hospital Medical School, London SW17 0RE, b Surrey Hampshire Borders NHS Trust, Ridgewood Centre, Old Bisley Road, Camberley, Surrey GU16 9QG, c Department of Renal Medicine, Kent and Canterbury Hospital, Ethelbert Road, Canterbury, Kent CT1 3NG, d Department of Renal Medicine, Salford Royal Hospitals NHS Trust, Hope Hospital, Salford M6 8HD and e Healthcare Management, Roche Products Ltd, 40 Broadwater Road, Welwyn Garden City, Hertfordshire AL7 3AY
Correspondence to Simon de Lusignan; Email: slusigna{at}sghms.ac.uk
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.
Keywords. Chronic kidney disease, computerised medical record, general practice, glomerular filtration rate, serum creatinine.
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