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Almost half of over-60s with CKD are undiagnosed, research suggests

Almost half of over-60s with chronic kidney disease may be undiagnosed, according to new research.

In response to the findings, a lead author suggested there 'could be value' in checking kidney function in patients with conditions such as hypertension or diabetes.

Primary care researchers in Oxford have found that the prevalence of CKD in people aged over 60 is around 18% and that almost half of these patients would be undiagnosed without screening.

The study, published in the British Journal of General Practice, recruited a total of 3,207 patients aged 60 or above from primary care. Patients were either classified as already having a CKD diagnosis or they underwent a screening assessment to determine their eGFR and ACR results.

They found that just over 300 patients already had a diagnosis, and just under 250 received a diagnosis via the screening assessment, corresponding to 10% and 8% of the whole cohort respectively.

This put the prevalence of CKD within the study population at 18%, with 44% of diagnoses occurring as a result of screening. The researchers suggested that without screening, almost half of the patients would not otherwise have known about their condition.

They said in the paper: ‘This suggests that the early stages of CKD (stages 1–3b) may be under-reported in the literature as many people are unaware that they have the condition. In the UK, some of these people will be picked up in the NHS Health Check Programme.

'However, only 43% of those invited for an NHS Health Check are reported to attend, and it is likely that many non-attenders will be those most at risk.’

Dr Jennifer Hirst, primary care researcher at the University of Oxford, commented: ‘Although widespread screening of all patients is unlikely to be cost effective, there may be value in checking kidney function in people living with other health conditions such as hypertension or diabetes. This will be established through long-term follow-up of this cohort.

‘Missed diagnoses may, over the long term, lead to an undetected decline in kidney function or untreated hypertension, potentially leading to an increase in GP consultations and referrals, if patients develop end-stage kidney disease or other health problems.’

Readers' comments (11)

  • Seb P

    Who exactly is this research designed to help?

    CKD 1-3 has barely any effect on anything, and the harm in labelling people with a “chronic disease” is not insignificant.

    I’m not surprised they’ve found people are under diagnosed, and I think we should praise the fact we are not over medicalising our over 60s.

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  • We need to have robust evidence that diagnosis improves outcomes for patients; telling apparently healthy people they are ill has adverse consequences for overall well-being.

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  • Absolutely agree with above. Lets celebrate not denigrate.

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  • David Banner

    The eGFR formula supplied from the lab is useless after age 75.
    An 85 year old with a creatinine of 80 has an eGFR less than 60 and is told they have CKD3.
    Yet the ACR and Cockcroft -Gault will often be normal.
    But hard pressed clinicians haven’t the time to do these extra checks, so will either ignore the eGFR or stick them on the CKD register, then do nothing, because there is nothing to do. Medicalisation of normal ageing is not progress.

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  • National Hopeless Service

    Ageing and its changes is a normal genetic process not an illness or disease.

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  • When would these researchers realize we cannot as yet fight old age. It is natural and not a disease. Giving labels and creating extra useless work that does not help anyone.

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  • True CKD should be progressive - eGFR falling 2-3 points per annum.

    How many patients have eGFR 50-60 for 10 years? They don't have any disease.

    What next? Annual health checks for everyone?

    You never know they might have dipped their eGFR from 59 to 58 OMG.

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  • I got sued when a patient had one reading in COD 4 and had been taking Diclofenac for years for severe generalised OA without problems

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  • Lead author suggests there "could be value" in checking renal function in diabetics and hypertensives-DOH!
    Could be value in talking to a real GP!!

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  • What exactly is a Primary Care researcher?

    The level of dissociation from reality, as DrDeath notes, is ketamine-tastic!

    talking of all things disso-ed, back in the day before the advent of the Novel Psychoactive Substances Act, when one could legally purchase ketamine analogues, the users/buyers of such compounds also referred to themselves as "researchers". Only they were independent and not affiliated with a university.

    Still, the spirit it would appear lives on.

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