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GPs warned CKD burden is only tip of the iceberg

GP workload over chronic kidney disease could rise still further after a new study detected huge numbers of hidden cases, writes Lilian Anekwe.

Researchers found a screening strategy similar to the QOF's was identifying only half of all CKD patients.

But fewer than 5 per cent of those detected via UK guidelines went on to develop

end-stage kidney failure, far lower than clinical trials have suggested.

The researchers said this strengthened the case for GPs taking on the management of CKD from specialists.

Their study, published online by the BMJ, assessed the effect of screening 65,604 Norwegians to UK Renal Association guidelines, which advise eGFRs for patients with high-risk conditions such as hypertension and diabetes.

Only 51.6 per cent of the total number of patients with stage 3-5 CKD were detected under the guidelines.

But a strategy screening everyone over 55 detected 93 per cent of cases.

Study leader Dr Stein Hallan, associate professor in medicine at the Norwegian University of Science and Technology, said the UK guidelines were inefficient, as nine patients had to be screened to detect a case of CKD – yet half of cases were missed.

But he said the low prevalence of end-stage renal disease meant GPs 'do not need to refer to a nephrologist immediately', but could manage cases until the disease progressed.

Dr Mick Eames, a GP in Market Rasen in Lincolnshire and joint chair of West Lincolnshire PEC, said: 'It's always been a worry that we're only detecting the tip of the iceberg, and that further patients might need investigating.'

Key conclusions

• Screening only high-risk patients by UK guidelines picks up just 51.6 per cent of patients

• Risk of progression to end-

stage renal failure was fewer than 5 per cent

• Many cases of CKD can be managed effectively by GPs

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