What's new in obstetrics and gynaecology
The drive to systematically identify patients with chronic kidney disease will lead to a huge surge in GP workload, a new study concludes.
GP researchers developed an automated search of practice records to identify patients with the condition – and found 92 per cent were currently undiagnosed.
Improved detection is a major focus of the new renal disease national service framework and ministers are pushing for CKD targets in the revised QOF. But GPs warned they will need a big increase in resources to cope with the extra burden of cases.
In the study, published in this month's Nephrology Dialysis Transplantation, researchers searched 10,975 patient records for serum creatine, cardiovascular illness and other risk factors (see box, below). They identified 492 patients with stages 3-5 CKD, only 40 of whom had been previously diagnosed.
Study author Dr Simon de Lusignan, a GP in Guildford, Surrey, and senior lecturer in primary care informatics at St George's, London, told Pulse: ‘It was a shock to see the proportion of our patients who have impaired renal function.'
He said it would now be feasible to roll out automated searching across the UK, but ‘GP education' was required.
GPs expressed concern over the resource and workload implications.
Dr Greg Place, a GP in Annesley Woodhouse and Nottinghamshire LMC chair, said: ‘If there's going to be the work we'd want to know if this is worthwhile. There would have to be more resources.'
Automated search program
The computer search identified patients with:
• Recorded serum creatine
• Principal modifiable causes of kidney disease:
– Cardiovascular co-morbidities
– Cardiovascular risk factors
– Drugs that can impair renal function
– Known renal disease– Diseases that might obstruct the urinary tract