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Call to revise QOF thresholds for CKD

Half of patients over the age of 75 years would be diagnosed with chronic kidney disease under QOF thresholds, researchers have found.

Thresholds for eGFR in elderly people should be cut from less than 60 to less than 45 ml/min/1.73m, the team from the University of Southampton suggest.

At this level CKD is more strongly associated with comorbidity, functional and cognitive impairment, and potentially reversible consequences such as anaemia, the researchers found.

The study of more than 15,000 patients in 53 UK general practices calculated a CKD prevalence of 56% - a figure which was higher among older age groups, women and those with cardiovascular disease or hypertension.

More severe CKD was much less common with only 3% having an eGFR less than 30 ml/min/1.73m.

The researchers estimated that around 2.5 million older people in the UK would be diagnosed with CKD under current QOF thresholds.

Study leader, Professor Paul Roderick, director of the Health Care Research Unit at Southampton University said: "Our findings suggest that we need to be more specific in identifying sub-groups of people at higher risks of progression or of CVD in older people with CKD stage 3.

"We found that over half of the older population were categorised as ‘diseased' at this level, and this was highest among the females."

Professor Mike Kirby, a GP in Radlett and professor of health and human sciences at the University of Hertfordshire agreed with the suggested threshold and said GPs should use proteinuria as a guide.

"A cut off of 60 if there's proteinuria is appropriate regardless of age but with no proteinuria, 45 is a more appropriate cut off in the elderly."

He added that the Royal College of Physicians of Edinburgh had reclassified CKD grade 3 into a and b depending on such findings.

"QOF doesn't distinguish and unfortunately there's a criteria that ACE inhibitors should be prescribed in the elderly.

"But if they have no proteinuria and their blood pressure is controlled they shouldn't be transferred just because of QOF."

The study is published early online in Age and Ageing (abstract).

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