Large-scale underdiagnosis of CKD says study
Significant numbers of people are not receiving diagnosis codes despite having evidence of chronic kidney disease, according to research presented at the 16th International Primary Care Diabetes Europe Conference.
Researchers found that in the majority of cases, a sustained reduction of estimated glomerular filtration rate (eGFR) below 60 did not lead to a chronic kidney disease (CKD) diagnosis code on a patient’s health record. eGFR is one of two tests used in primary care to diagnose CKD and a result below 60 places a patient into stage 3 to 5, indicating that the patient is at high risk of an adverse event.
The retrospective analysis of electronic health record data across 60 NHS England primary care centres between 2012 and 2022 showed that only 45% of type 2 diabetes patients with eGFR-based evidence of CKD received a CKD diagnosis code.
CKD diagnosis is incredibly hit-and-miss across the NHS right now as a result of the massive capacity and resource restraints on primary care. Dr Waqas Tahir
For those that did have a diagnosis code, the average delay between patients meeting the eGFR criteria for CKD and a diagnosis code being recorded was 9.8 months, but in 44% was over 12 months. The research was led by data scientists from British health data start-up Gendius, as well as Dr Waqas Tahir, GP and Diabetes Clinical Lead for West Yorkshire & Harrogate ICS.
Dr Waqas Tahir said: “CKD diagnosis is incredibly hit-and-miss across the NHS right now as a result of the massive capacity and resource restraints on primary care. At our practice, we were able to fund a CKD review which increased our CKD patient register by 34%. However, without that funding, those patients would have gone undiagnosed and their kidney function would have continued to decline.
“There are National conversations happening at the moment to increase the financial incentives for primary care to diagnose CKD, which are desperately needed for practices to improve their standards of care. We know that the impact of undiagnosed CKD is huge, and that prompt diagnosis and treatment are essential for preventing progression to kidney failure, so this absolutely needs to be a priority area for primary care.”
The research illustrates the persistent problem of underdiagnosis and poor CKD management within NHS primary care and demonstrates the need for more dynamic solutions that can reduce primary care workload. Researchers say a potential solution could be an automated CKD patient registry and diagnostic coding tool that works within the electronic health record to identify, inform and prioritise patients, enabling early intervention to delay progression to end-stage disease.
CKD affects over 850 million people worldwide, and more than 40% of people with diabetes will develop CKD. Even in the early stages, CKD is associated with reduced life expectancy, and early treatment is essential for improving patient outcomes. CKD is known to be underdiagnosed because it does not usually have symptoms in the early stages. As many as nine in 10 adults with CKD are unaware that they have it.
Dr Natasha Patel, Consultant Diabetologist, St George’s University Hospitals NHS Foundation Trust, comments, “The real challenge when it comes to chronic kidney disease is that it is asymptomatic in its early stages, and at the moment we don’t have a great way of identifying people who are in the very early stages of CKD. The national screening programme uses blood testing to diagnose CKD, but if people do not feel unwell, they may feel that it is not necessary and often miss or postpone their screening appointments.”
A pre-print of the full research paper of the study, ‘Diagnosis coding of Chronic Kidney Disease in Type 2 Diabetes in UK primary care’, is available to view here.