Fraser Simon D S, Parkes Julie, Culliford David, Santer Miriam, Roderick Paul J
Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, South Academic Block, Southampton General Hospital, Tremona Road, Southampton, Hampshire, SO16 6YD, UK.
Academic Unit of Primary Care and Population Sciences, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK.
BMC Fam Pract. 2015 Feb 13;16:18. doi: 10.1186/s12875-015-0235-8.
Chronic kidney disease (CKD) is predominantly managed in primary care in the UK, but there is evidence of under-identification leading to lack of inclusion on practice chronic disease registers, which are necessary to ensure disease monitoring. Guidelines for CKD patients recommend urinary albumin to creatinine ratio (uACR) testing to identify albuminuria to stratify risk and guide management. This study aimed to describe the pattern and associations of timely CKD registration and uACR testing.
A retrospective cohort of individuals with incident CKD 3-5 (two estimated glomerular filtration rates (eGFR) <60 ml/min/1.73 m(2) ≥ three months apart) between 2007 and 2013 was identified from a linked database containing primary and secondary care data. Descriptive statistics and Cox proportional hazards models were used to identify associations with patient characteristics of timely CKD registration and uACR testing (within a year of first low eGFR).
12,988 people with CKD 3-5 were identified from 88 practices and followed for median 3.3 years. During this time period, 3235 (24.9%) were CKD-registered and 4638/12,988 (35.7%) had uACR testing (median time to CKD registration 307 days and to uACR test 379 days). 1829 (14.1%) were CKD-registered and 2229 (17.2%) had uACR testing within one year. Amongst people whose CKD was registered within a year, 676/1829 (37.0%) had uACR testing within a year (vs. 1553/11,159 (13.9%) of those not registered (p < 0.001)). Timely uACR testing varied by year, with a sharp rise in proportion in 2009 (when uACR policy changed). Timely CKD registration was independently associated with lower eGFR, being female, earlier year of joining the cohort, having diabetes, hypertension, or cardiovascular disease but not with age. Timely uACR testing was associated with timely CKD registration, younger age, having diabetes, higher baseline eGFR and later year of joining the cohort.
Better systems are needed to support timely CKD identification, registration and uACR testing in primary care in order to facilitate risk stratification and appropriate clinical management.
在英国，慢性肾脏病（CKD）主要在基层医疗中进行管理，但有证据表明存在识别不足的情况，导致患者未被纳入诊所慢性病登记册，而这些登记册对于确保疾病监测是必要的。CKD患者指南建议进行尿白蛋白与肌酐比值（uACR）检测，以识别蛋白尿，从而进行风险分层并指导治疗。本研究旨在描述CKD及时登记和uACR检测的模式及相关性。
从一个包含基层医疗和二级医疗数据的关联数据库中，确定了2007年至2013年间患有新发CKD 3 - 5期（两次估算肾小球滤过率（eGFR）<60 ml/min/1.73 m²，间隔≥三个月）的个体的回顾性队列。使用描述性统计和Cox比例风险模型来确定与CKD及时登记和uACR检测（在首次eGFR降低后的一年内）的患者特征的相关性。
从88个诊所中识别出12988例CKD 3 - 5期患者，中位随访时间为3.3年。在此期间，3235例（24.9%）进行了CKD登记，4638/12988例（35.7%）进行了uACR检测（CKD登记的中位时间为307天，uACR检测的中位时间为379天）。1829例（14.1%）在一年内进行了CKD登记，2229例（17.2%）在一年内进行了uACR检测。在一年内进行CKD登记的患者中，676/1829例（37.0%）在一年内进行了uACR检测（未登记患者中为1553/11159例（13.9%），p < 0.001）。及时进行uACR检测的比例随年份有所变化，2009年（uACR政策改变时）比例大幅上升。CKD及时登记与较低的eGFR、女性、较早加入队列年份、患有糖尿病、高血压或心血管疾病独立相关，但与年龄无关。及时进行uACR检测与CKD及时登记、较年轻的年龄、患有糖尿病、较高的基线eGFR以及较晚加入队列年份相关。
需要更好的系统来支持基层医疗中CKD的及时识别、登记和uACR检测，以便于进行风险分层和适当的临床管理。
