Monitoring chronic kidney disease in primary care

AIMS:

This study aims to gather evidence to help develop more effective ways to monitor patients with chronic kidney disease in the UK primary care. The study will aim to develop and populate a clinical and economic model of renal function decline, and to then estimate the effectiveness and cost-effectiveness of different models used for monitoring.

Why this is important:

We are living longer and healthier lives due to health promotion, better medical care and improved disease prevention. However, this means that as many of us age, we may live longer with a chronic condition, such as diabetes, kidney disease, or coronary heart disease. How long-term conditions such as these are monitored is a major factor in their effective management.  About 2 million adults in England have been diagnosed with moderate to severe chronic kidney disease. The majority of monitoring in these patients occurs in mild/moderate disease by general practitioners (GPs) in primary care, with only the final stages of disease managed in secondary care.

Current monitoring of chronic kidney disease is based on a measure called estimated glomerular filtration rate (eGFR) that shows suboptimal performance in the population typically managed in primary care (elderly people with mild to moderate stage chronic kidney disease). In addition, current guidelines for the frequency of measurement of eGFR are based on expert consensus, owing to lack of evidence.

methods:

Firstly, we will gather a picture of the current practice and evolving trends for monitoring chronic kidney disease in primary care.  This will use both local data going back 20 years from the Department of Clinical Biochemistry of the Oxford Radcliffe Hospitals Trust and national data from the Clinical Practice Research Datalink (CPRD).  The variability, both long-term and short-term, in eGFR and related measures will also be estimated using CPRD and two additional large datasets.

The current evidence base will further be examined by completing three systematic reviews:

• compare the various equations used to estimate eGFR
• identify previous cost effectiveness models of monitoring patients with chronic kidney disease
• review current drug treatments that are known to modify the progression of chronic
• kidney disease. 

A cohort study, FORM 2C, will be undertaken to determine whether the current move to a cystatin based calculation of eGFR is justified.

Finally, the human and practical aspects of all of the above research will be explored in focus groups and interviews with patients and health professionals.  In addition, an economic model will be developed to determine the most cost-effective modelling strategy for patients with CKD.

The research team will be supported by a stakeholder group consisting of patients, public and health professionals.