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Measure creatinine in all ill older patients, recommends NICE

GPs should measure the creatinine levels of all patients aged 65 years and over with an acute illness in order to detect those with acute kidney injury, say new guidelines from NICE published today.

The new guideline recommends GPs test creatinine levels in all patients with an acute illness aged 65 years, and all adults with conditions such as chronic kidney disease, heart failure, liver disease or diabetes.

It also recommends serum creatinine is measured to detect kidney damage in all young patients with acute illness who have conditions such as chronic kidney disease, heart failure and history of acute kidney injury.

Dr Mark Thomas, nephrologist at Heart of England NHS Foundation Trust and chair of the NICE guideline development group said: ‘The NICE recommendations give the NHS clear advice to reduce the number of avoidable deaths through acute kidney injury.’

Dr Kathryn Griffith, RCGP clinical champion for kidney care and a GP in York, welcomed the new guideline and said that GPs play a ‘key role’ in identifying and treating patients with acute kidney injury.

She said: ‘The more patients identified and treated in primary care, the better, both for our patients and the NHS.

‘The NICE guidelines outline important courses of action for GPs to identify patients who are most at risk of acute kidney injury, how to test for and diagnose the condition, and how to treat it.’

Readers' comments (4)

  • So how do they expect this to be done on a practical level?

    If I'm doing it myself, my appointment will have to be 15-20min (and how do I predict that before they arrive?) and DoH will somehow have to cater patients that can't get an appointment in already stretched primary care.

    If a phlebo is doing this will they pay for a HCA to be on site everyday from 8-6:30 and also pay for carrier to the lab at 6:30pm?

    And who will action the result for the ones that comes back after the surgery has closed? And how will the labs be funded inorder to cope with influx of tests?

    Pie in the sky.............

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  • Vinci Ho

    I would have thought checking FBC and U&E(these days with creatinine/eGFR) are 'natural' reflex when you have to investigate.......

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  • Unfortunately this is not a particularly helpful document as it appears to be written for hospital staff but publicised as being for GPs. I note there was one GP amongst the 18 strong panel supposedly writing a document to 'increase awareness amongst primary care professionals'. They also suggest being over 65 and ill is a reason to check the creatinine but without qualifying this - most people with a cold would classify themselves as ill and many come to see a doctor on this basis - can the health system cope with doing blood tests on all these people? This too vague and further medicalising people - a good message lost here.

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  • Thank you NICE, but I already know how to do my job. I've even got a few degrees to prove it.

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