Project supported by
A Package of Innovation for
managing kidney disease
in primary care
POI Step 1 - Validation of your chronic kidney disease (CKD)
register (CKD Stages 3-5)
Introduction
There are a number of ways in which you can check whether your CKD Register is accurate. Whichever
method you choose, it is important to first have an idea of the expected prevalence of stages 3-5 CKD in
your current practice population (aged 18 years and over).
The following data has been taken from the QI-CKD study 2007-2011 (data exported from almost 1m
patient records in 130 practices in England) and you can use these to work out the expected number of
patients for your practice population (18 years and over) whose names should appear on the Register. In
general terms you can expect 6-7% of your Practice population over 18 years to have CKD. Note: If your
population is elderly or very young then you may need to adjust the prevalence up or down.
CKD Stage
Stage 3A
Stage 3B
Stage 4
Stage 5
Total 3-5
Total
5.65%
0.90%
0.16%
0.05%
6.76%
Females
7.71%
1.16%
0.19%
0.05%
9.11%
Males
3.57%
0.64%
0.13%
0.05%
4.39%
NB The classification of CKD has now been
amended to include a combination of both
eGFR and ACR (see NICE CKD Guidance
2014 cg182) but this table still provides an
estimate of prevalence of CKD stages 3-5
(GFR categories 3-5).
Methods of validation
1. The manual method
a) Review patients currently on your CKD Register to see if all have two eGFR readings <60 more than
three months apart. Remove those who do not meet these criteria. If any patient on the CKD Register has
just one eGFR <60, then call them in for further eGFR.
b) Subtract number of patients on your updated CKD register to estimate approximate number of people
with CKD3-5 to be “found”.
c) Next scrutinise the following QOF Registers, which cover other long term conditions that frequently
co-exist with CKD:
DM19: The practice can produce a register of all patients aged 17 years and over with diabetes mellitus
BP1: The practice can produce a register of patients with established hypertension
CHD1: The practice can produce a register of patients with coronary heart disease
HF1: The practice can produce a register of patients with heart failure
STROKE 1: The practice can produce a register of patients with stroke or TIA
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POI Step 1 - Validation of CKD register continued...
d) Work down each Register and check if:
i) Patient has 2x eGFR readings <60 more than three months apart.
If yes, then check if already on the re-validated CKD Register (from 2), and if not, add their name to the CKD Register and add Read code (1Z10 CKD stage 1 though to 1Z14 - CKD stage 5).
ii) Patient’s most recent eGFR is <60, but previous eGFR are >60 or not available.
If yes, then call the patient in for an additional eGFR (at least three months after most recent eGFR). If no, then no action required.
e) There may be up to 10% patients not on the Registers in (3) who have CKD. Search all current patients
who have had an eGFR taken in past five years and check result. Either add to CKD Register if the two
most recent eGFR readings are both <60 and are at least three months apart, or call patient in for
additional eGFR if patient’s most recent eGFR is <60, but previous eGFR are >60 or not available.
Add name to CKD Register if criteria for CKD met and add Read Code (1Z10 CKD stage 1 though to
1Z14 - CKD stage 5).
f) There may be a small number of patients whose eGFR varies from 56 to >60. This anomaly may be
due to the estimation of the results – monitor these patients on an annual basis.
2. Automated methods
a) CKD Finder on EMIS LV
This search tool identifies people who have had 2 x eGFRs <60 more than three months apart. However
this search is there to help you identify patients who may have CKD, but not complete the diagnosis.
A clinical interpretation of the lab results should always be undertaken prior to diagnosing CKD. You
will still need to manually apply the appropriate Read code (1Z10 CKD stage 1 though to 1Z14 - CKD
stage 5) to the patient’s record. A User Guide from EMIS on the CKD Finder (TH361 LV Chronic Kidney
Disease Reports) is available from:
www.emis-online.com
b) The IMPAKT CKD tool
IMPAKTTM is an innovative and integrated programme of work taking place in primary care to help
identify people with chronic kidney disease (CKD) and prevent patients from developing progressive
kidney disease.
IMPAKTTM has evolved from extensive work conducted by the Collaboration for Leadership in Applied
Health Research and Care (CLAHRC) for Greater Manchester and the CLAHRC for Leicestershire,
Northampton and Rutland, in partnership with primary care. Involving a simple, innovative research
audit tool (The IMPAKTTM CKD Tool), coupled with evidence-based, pragmatic quality improvement (QI)
strategies that have been refined in practice, IMPAKTTM leads the way in assisting primary care in the
identification and management of people with CKD. IMPAKTTM can lead to improved health
outcomes for many patients.
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© Kidney Research UK
POI Step 1 - Validation of CKD register continued...
IMPAKTTM will:
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Identify all CKD patients in any practice
Analyse the accuracy of clinical coding
Risk stratify patients against pre-defined clinical parameters and support patient management against national clinical guidelines
Improve clinical knowledge and management
Provide support for patients to manage their CKD and help with practice capacity to improve care for other long-term conditions
The IMPAKTTM CKD Tool is a Miquest based extraction/audit tool and has been designed to work with all
GP practice systems.
www.impakt.org.uk
Revised Sept 2014
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Registered Charity No. 252892. Registered Scottish Charity No. SC039245
© Kidney Research UK