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Workload to soar as one in 10 set for CKD diagnosis

GPs face an unprecedented surge in workload over the chronic kidney disease indicators in the revised quality and outcomes framework.

A series of new audits reveal that 10 per cent of a GP's entire practice population will be diagnosed with CKD under the framework's eGFR algorithm.

The figure is almost twice as high as previously estimated and far greater than the GPC was anticipating when it agreed to the QOF revisions.

Researchers warned that controlling CKD patients to the stringent 140/85mmHg blood pressure target would be a 'very serious' burden on practices and would put severe pressure on prescribing budgets.

A study to be presented to May's British Renal Society and Renal Association conference in Harrogate reanalysed data on 41,051 patients, and revised estimates of CKD prevalence upwards from 5.7 to 9.6 per cent.

A second audit used existing creatinine data to calculate eGFRs in 1,619 patients and identified CKD in 453 ­ a practice prevalence of 11 per cent.

Dr Gwion Rhys, who carried out the second audit at his practice in Nefyn, Pwllheli, said: 'You are talking massive figures here.

'It's going to be a very serious increase in workload, mainly because the hypertension target is far more stringent for people with these markers. At a sweep 10 per cent of the practice population is going to have a very aggressive new target.'

A third study to be presented in Harrogate found using eGFR to identify CKD sent referrals to renal services spiralling by up to five-fold.

GPs were uncertain on how to manage newly identified cases, with researchers rating 40 per cent of referrals inappropriate.

Study leader Dr Nick Rich-ards, medical director of Optimal Renal Care UK and former consultant nephrologist, said: 'In an average practice of 2,000 patients there will be about 200 with CKD.

'At present only a small proportion of those patients will have been recognised.'

Dr Simon De Lusignan, senior lecturer in primary care informatics at St George's Hospital Medical School and a GP in Guildford, Surrey, warned: 'It

is like finding another diabetes.'

The GPC admitted a 10 per cent prevalence was higher than it had expected.

Dr Laurence Buckman, GPC deputy chair, said: 'I'm very impressed at the 10 per cent figure. I would have had it very much lower. There will clearly be cost implications.'

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