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New dialysis patient numbers have plummeted, but is your GP practice doing its bit?

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Dialysis treatment is necessary for many patients with chronic kidney disease, but earlier diagnosis by GPs has helped to reduce this need. Not only is this good news for patients (dialysis is a treatment that may need regular hospital visits and restriction of diet), it's also good news for the NHS: when dialysis is avoided by early diagnosis, both money and time are saved.

During its inspections, the CQC actively looks for evidence that your patients are being actively tested (last year, for example, Buckfastleigh Medical Centre was singled out for outstanding practice in this area).

New dialysis patient numbers nearly halve in ten years

The early diagnosis of CKD patients has been directly attributed to a massive reduction in new dialysis patients over the last ten years: from one in three CKD patients starting dialysis to less than one in five.

However, the CKD audit believes that further inroads are possible. It highlights a wide variation in diagnostic testing and points to urine testing being especially underused. While the CKD audit found that almost 90% of GPs conducted annual blood tests, only marginally more than half conducted annual urine tests.

What and when should you test?

NICE recommends annual monitoring of CKD and to identify patients at risk. Its recommendations are for:

  • Blood tests for eGFR
  • Urine tests for albumin-to-creatinine ratio

Given the audit findings, it's probable that at one in every two GP practices reading this blog are underutilising urine testing. There could be various reasons for this, including:

  • The test isn't properly explained to patients
  • Patients find the test awkward
  • It is a test which is easy to miss on an annual check-up

Is your GP practice using urine testing effectively?

With around one in 20 adults affected by CKD in the UK, there is a high probability that around 5% of your adult patients will be sufferers. These most at risk include patients with diabetes and high blood pressure. Like high blood pressure, most CKD sufferers exhibit few or no symptoms until the disease has reached its advanced stages. Some patients will then develop cardiovascular disease or acute kidney injury.

Speaking about CKD, Dr Richard Fluck, former National Clinical Director (renal) at NHS England, said: "Chronic kidney disease is important, and whilst we have made significant progress in diagnosis and treatment over the last decade there is still unmet need in care.

"Historically, CKD was often not diagnosed in a timely way, reducing options to slow disease progression and prepare people for the possibility of kidney failure. This occurred in about one in three people starting dialysis over a decade ago and is now less than one in five."

He said that this improvement is principally due to the skills of primary care in understanding the need to detect and manage CKD.

Is your practice utilising urine testing to its best effect, and reducing the need for patients to begin dialysis treatment? What is the ratio of your CKD sufferers beginning dialysis treatment, and how does that measure up to the national average?

For more information, visit the National CKD Audit website. As Fiona Loud, Policy Director at the British Kidney Patient Association said: "The report can help GPs to make best use of resources by focusing on, monitoring and managing those at risk, preventing complications and deterioration where possible."

eSupplies Medical is a trading name of Williams Medical Supplies Ltd, a DCC business