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CKD controversies

From Dr Sue Robertson and

Dr David Strachan, Dumfries

As a nephrologist and GP husband and wife, we read your articles in Pulse with interest and have comments on chronic kidney disease (News, 15 February and 8 February).

Regarding debate over whether to report eGFRs >60, in Scotland it was decided by our biochemists and nephrologists together that our labs would only report a number when eGFR <60. the="" 4="" variable="" mdrd="" equation="" is="" just="" not="" accurate="" enough="" at="" higher="" levels="" of="">

Regarding parathyroid hormone and vitamin D, one researcher suggested these are checked only in CKD if 'progressing rapidly to stage 4'. These are the very people who should definitely be referred to nephrologists as we need to try to slow or arrest that progress and, if not, prepare them for dialysis and transplantation.

We can now put someone on the transplant list if they are within six months of requiring dialysis so they may be lucky enough to get a 'pre-emptive' transplant. If this is the case, perhaps the tests need not be done in primary care at all.

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