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CAMHS won't see you now

Partnership will help CKD workload surge

From Dr Indranil Dasgupta, consultant nephrologist, Birmingham

I read the article on the increase in the number of CKD patients in primary care with interest, as it highlights the need for education and clear guidance (News, 24 August). Early identification of CKD in primary care is essential as it gives the opportunity to manage cardiovascular risk factors and reduce the high risk of

cardiovascular morbidity

and mortality in these

patients, to slow progression

to end stage kidney disease

and to identify patients who will need dialysis at an early stage.

At the Heart of England Foundation Trust, we have

been automatically reporting eGFRs since January 2004. GFR estimates are only reported when the serum creatinine concentration is above the

laboratory assay's reference range (for our assay this is 80 micromols/l for women and

106 for men). We contend that

estimates of GFR derived from

creatinine values in the reference range do not add clinically useful information to the result and often cause unnecessary anxiety.

With help from a local GP practice, we developed a simple flow chart for the management of patients with CKD, which is available at: We have also run a series of CKD education sessions for GPs and practice nurses.

In the first year, referrals increased by 25 per cent but the additional numbers of patients could be treated and monitored in primary care, as per the flow chart. Letters of advice specific to each patient were sent to the referring GP, rather than a routine outpatient appointment being offered.

We have also set up systems to help manage CKD in the community, including regular training sessions for practice nurses and the establishment of a community CKD nurse.

National initiatives to train

GPs are also under way,

including the 'Train the Trainers' Warwick Kidney Care Course (see www2.warwick.


With a rational eGFR reporting system, a thorough education programme and true partnership between primary and secondary care, our local GPs have become more confident in managing CKD, the outpatient service is controlled and an improved service is being provided for patients.

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