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Chronic kidney disease patients need better preventive care by GPs, says study



Chronic kidney disease patients are at an increased risk of hospitalisation for heart failure, infection, and acute kidney disease, according to a new study of nearly half a million patients.

Researchers from the London School of Hygiene and Tropical Medicine and University College London said the findings highlight the need for both better identification of chronic kidney disease (CKD) in primary care and improved preventive care.

The study, published in the BJGP, combined primary care data from the national Clinical Practice Research Datalink service with information from the Hospital Episode Statistics programme, which includes details of all hospital admissions at NHS hospitals in England.

Patients with CKD and a comparison group of patients without known CKD – matched for age, sex, GP, and calendar time – were then identified between 2004 and 2014. A total of 242,349 pairs of patients – with and without CKD – were included.

The research team found the largest difference between CKD patients and non-CKD patients was for heart failure, which had a difference rate of 6.6/1000 person-years.

Although urinary tract infections, pneumonia and AKI followed closely behind with difference rates of 5.2, 4.4 and 4.1 respectively. The relative risk was highest for AKI, and heart failure.

The researchers said the results showed these conditions should be ‘targets for improved preventive care’.

They said: ‘These findings suggest that, aside from prevention of end-stage kidney disease, there are important high-priority outcomes that warrant identification of CKD in primary care and improved preventive care of patients with CKD in the community.’

The paper added: ‘Based on results from this study, a focus on strategies to reduce hospitalisations for heart failure, such as education on dietary salt restriction and improved medication adherence, could help to minimise the difference in the overall hospitalisation rate between patients with and without CKD.

‘Similarly, a proportion of hospitalisations due to infections may be preventable through prompt antibiotic treatment and improvement of vaccination coverage among patients with CKD. Pneumococcal vaccination has been underutilised in patients with CKD (stages 4 and 5) to date.’

GPs have previously been warned that anticoagulants may increase the risk of stroke for CKD patients, and so should weigh up the risks and benefits before initiating such treatment.