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Independents' Day

CKD targets set for radical overhaul

By Nigel Praities

The chronic kidney disease indicators in the quality framework are set to be overhauled after Government advisers recommended substantial changes.

GPs are likely to be asked to stratify patients using proteinuria testing – with tough new blood pressure targets for those at highest risk.

The recommendations to the QOF review aim to ‘close the gap' to February's national consensus statement on CKD, which warned the QOF indicators were in need of refinement.

The consensus statement, by the Royal College of Physicians and the Renal Association, called for ACE inhibitors and ARBs to be targeted at patients with proteinuria, with the option to exception report others.

Dr Kathryn Griffith, a GP in York who contributed to the expert review report on CKD, told Pulse she had recommended a separate indicator on proteinuria testing.

Dr Griffith, who is also a member of the Department of Health renal advisory group, said: ‘Proteinuria is the best indicator of a patient who is either going to have rapidly deteriorating kidney failure or is at particularly high risk of cardiovascular complications.'

She has also advised toughening up the QOF blood pressure target for patients with proteinuria from the existing threshold of 140/85mmHg.

Dr Donal O'Donoghue, the Government's renal tsar and clinical director of renal medicine at Hope Hospital in Salford, said the department had submitted separate evidence to the QOF review, but that he supported Dr Griffith's proposals.

He said he expected the QOF to move towards a clinical blood pressure target of 125/75mmHg for patients with proteinuria. ‘I would expect audit thresholds to improve year on year, to get closer to the clinical target.'

GPs scored almost 100% in the first year of CKD targets, but only by exception reporting almost 30% of patients for CKD3.

Dr O'Donoghue also said the range of blood pressure targets in the QOF was ‘confusing', and that he favoured harmonising them, with equally strict blood pressure indicators for patients with diabetes and proteinuria.

The expert evidence is being collated by Dr Simon de Lusignan, a GP in Guildford, Surrey, and senior lecturer in primary care informatics at St George's Hospital, London.

He told Pulse it was time to ‘close the gap' between existing guidance and the consensus statement. ‘We made a relatively unsubtle but straightforward start in CKD and now there is a need to make it that bit more sophisticated.'

How the QOF is set to change

• New indicator for proteinuria testing
• Tougher blood pressure targets for patients with proteinuria, towards a clinical target of 125/75 mmHg
• Harmonisation of blood pressure targets with those for diabetes
• Focus on patients with moderate to severe CKD(GFR <>

Source: Dr Kathryn Griffith, member of QOF expert panel on CKD

Dr Kathryn Griffith: tougher blood pressure targets on way for patients with proteinuria Dr Kathryn Griffith: tougher blood pressure targets on way for patients with proteinuria

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