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Clarify QOF's CKD in older people

From Dr R Kenny

Ahoghill, Northern Ireland

Like many of my colleagues I am concerned about the new CKD clinical domain. Undoubtedly, strict control of hypertension, dyslipidaemia and diabetes will slow down progressive kidney decline. But the sole criterion in the QOF is the estimated glomerular fitration rate (eGFR).

An eGFR of 59 or less will automatically include the patient in the register of those with CKD stage 3-5. We will lose points if that patient is not on an ACE inhibitor or ARB and their blood pressure is not <140 5.="" this="" is="" clinically="" sound="" in="" younger="" patients="" but="" it="" appears="" the="" egfr="" is="" accurate="" only="" up="" to="" the="" age="" of="">

I have found numerous eGFRs of 59 or less in the older population, many with well-controlled BP/diabetes. I have a problem putting a lot of these older people on ACE/ARB drugs or driving their BPs even lower.

Surely there must be some sort of clarification in these older people, or do we exception report after the age of 70 as unsuitable, due to the inaccuracy of the eGFR?

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