Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow.
General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow.
Br J Gen Pract. 2023 Jan 26;73(727):e141-e147. doi: 10.3399/BJGP.2022.0145. Print 2023 Feb.
National Institute for Health and Care Excellence 2021 guidelines on chronic kidney disease (CKD) recommend the use of the Kidney Failure Risk Equation (KFRE), which includes measurement of albuminuria. The equation to calculate estimated glomerular filtration rate (eGFR) has also been updated.
To investigate the impact of the use of KFRE and the updated eGFR equation on CKD diagnosis (eGFR <60 mL/min/1.73 m) in primary care and potential referrals to nephrology.
Primary care database (Secure Anonymised Information Linkage Databank [SAIL]) and prospective cohort study (UK Biobank) using data available between 2013 and 2020.
CKD diagnosis rates were assessed when using the updated eGFR equation. Among people with eGFR 30-59 mL/min/1.73 m the following groups were identified: those with annual albuminuria testing and those who met nephrology referral criteria because of: a) accelerated eGFR decline or significant albuminuria; b) eGFR decline <30 mL/ min/1.73 m only; and c) KFRE >5% only. Analyses were stratified by ethnicity in UK Biobank.
Using the updated eGFR equation resulted in a 1.2-fold fall in new CKD diagnoses in the predominantly White population in SAIL, whereas CKD prevalence rose by 1.9-fold among Black participants in UK Biobank. Rates of albuminuria testing have been consistently below 30% since 2015. In 2019, using KFRE >5% identified 182/61 721 (0.3%) patients at high risk of CKD progression before their eGFR declined and 361/61 721 (0.6%) low-risk patients who were no longer eligible for referral. Ethnic groups 'Asian' and 'other' had disproportionately raised KFREs.
Application of KFRE criteria in primary care will lead to referral of more patients at elevated risk of kidney failure (particularly among minority ethnic groups) and fewer low-risk patients. Albuminuria testing needs to be expanded to enable wider KFRE implementation.
国家卫生与保健卓越研究所（NICE）2021 年关于慢性肾脏病（CKD）的指南建议使用肾脏衰竭风险方程（KFRE），该方程包括白蛋白尿的测量。估计肾小球滤过率（eGFR）的计算公式也已更新。
调查在初级保健中使用 KFRE 和更新的 eGFR 方程对 CKD 诊断（eGFR <60 mL/min/1.73 m）的影响，以及潜在的转介到肾病科的情况。
初级保健数据库（安全匿名信息链接数据库[SAIL]）和前瞻性队列研究（英国生物库），使用 2013 年至 2020 年期间的数据。
评估使用更新的 eGFR 方程时 CKD 的诊断率。在 eGFR 为 30-59 mL/min/1.73 m 的人群中，确定了以下人群：每年进行白蛋白尿检测的人群和因以下原因符合肾病科转介标准的人群：a）eGFR 下降加速或显著白蛋白尿；b）仅 eGFR 下降 <30 mL/min/1.73 m；和 c）KFRE >5%。在英国生物库中按种族进行分析。
在 SAIL 的主要为白人的人群中，使用更新的 eGFR 方程导致新的 CKD 诊断率下降了 1.2 倍，而在英国生物库的黑人参与者中，CKD 的患病率上升了 1.9 倍。自 2015 年以来，白蛋白尿检测率一直低于 30%。2019 年，使用 KFRE >5%可识别出 182/61721（0.3%）名在 eGFR 下降之前发生 CKD 进展风险较高的患者和 361/61721（0.6%）名不再符合转介标准的低风险患者。“亚洲”和“其他”族裔人群的 KFRE 异常升高。
在初级保健中应用 KFRE 标准将导致更多处于肾衰竭风险升高（特别是在少数族裔群体中）的患者被转介，而较少低风险的患者被转介。需要扩大白蛋白尿检测以实现更广泛的 KFRE 实施。
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