Why does CKD matter?

CKD matters because in advanced stages it carries a higher risk of morbidity and mortality. However, there is evidence that if CKD is diagnosed early, treatment can prevent the progession of CKD itself, and in turn reduce or prevent complications and reduce the risk of cardiovascular disease. Early diagnosis is a challenge as there are few symptoms obvious to a patient or clinican. Developing ways of identifying patients early and preventing patients progressing to end stage renal failure are needed. Taking part in this national CKD audit will help to determine these strategies.

How can I improve care for my CKD patients?

There are a number of ways of helping you improve your care of CKD patients. By using the optional CKD audit quality improvement tool on your PC and running it when reviewing a patient record, the tool will present a pop-up box if the patient record indicates the possibility of CKD without actually being coded as such. It is possible to activate additional pop-ups to guide you in a variety of related decisions. To adjust your prompts setup, see "How can I adjust the prompts?" below.

Why do I need another CKD QI Tool?

The National CKD Audit team support QI in all it's forms. We have included a QI tool within the Audit which you may use if you want, but if you have existing tools or processes to improve care in CKD you may chose to continue to use them without affecting your participation in the Audit.

Whether you use the QI tool provided or not, the Audit tool should be installed in order that your data can contribute to mapping the national picture of CKD care.

What's in it for me?

Once enabled, the audit tool will provide you with tools to help manage your patients; as well as automatically managing data extraction without further input from staff at your Practice. 

5 Reasons to Participate:

  1. An accurate CKD code promotes safe prescribing and reduces the risk of Acute Kidney Injury (and therefore of unplanned admission).
  2. The tool assists with the management of CKD in line with NICE guidance.
  3. Accurate community data enables fair commissioning by taking account of people with CKD who have the highest risk for Cardiovascular Disease.
  4. Local data from the audit is readily available to the practice and appropriate for use in appraisal and revalidation.
  5. The English QOF rewards GPs for keeping a CKD register.

What other benefits does the audit give me to manage my patients' care?

The audit tool will analyse your patient list overnight to present you with a report each morning. This will indicate the patients and their status, helping you take action where it is needed to manage the patient's condition.

How much work does it entail for a participant?

The audit tool will run automatically so requires no extra work once it is installed.

The tool will identify patients who may need coding for CKD and those who might need monitoring blood tests. This work will improve patient care and help the practice meet QOF responsibilities and NICE guidelines.

The tool will also help identify potential improvements to the management of these patients particularly with regard to BP management and specialist referral.

What do I need to do to install the software?

Please click here for instructions on how to get started.  If you don't have permission to download or install the software you might need to contact your local IT support team for help.

Are there benefits to having the software installed other than to feed into the two rounds of data collection?

The tool will enable you to take a systematic approach to the care and identification of patients with CKD. The aim is that better information will enable you to improve the care of patients with CKD and reduce the number of patients suffering the long term consequencies of CKD. Improving the identification of patients with CKD will also feed into your QOF register and improve your QOF points for CKD.

Do I get measured against my peers?

Not for the first round. You will be informed of your position, but it won't be published. You can take advantage of the QI tool to improve your position, so that when the second round of data is analysed, you can expect to have improved.

How much information about my practice and how well it's done in the programme is going to be published?

The outcomes of the first data extraction will be for practice use only. This will allow practices to examine their own coding approach and data completeness before the second extract. This is because variation in the first extract are more likely to reflect the complexity and number of different ways CKD is coded rather than misidentification or a variation from national prevalence and we will be looking to work with practices where variations occur.

Data from the second extract will be available to the practices themselves and reported to the CCG at a practice identifiable level. The initial data extractions are unlikely to produce useful comparisons.

Some people have suggested that classifying people as having CKD means overlabelling patients with diseases without any evidence of benefit. Why are trying to improve the identification of a condition if it won't improve peoples outcomes?

Although very few patients with CKD go on to need dialysis or kidney transplants there are other important reasons to know if someone's kidney function is abnormal.

Firstly, patients with CKD are at higher risk of strokes and heart diseases, knowing who these patients are means GPs can prioritise preventative measures aimed at reducing the burden of vascular disease in this group.

Secondly, patients with CKD have an increased risk of acute kidney injury (kidney failure) when they become ill for other reasons. Knowing who these patients are means that monitoring can be performed, preventative measures instituted early on and further help obtained if necessary.

Thirdly some medications need to have doses adjusted or even should be avoided completely in people with abnormal kidney function. Knowing who has CKD means prescribing is safer and better advice can be given to patients about any medicines the buy from pharmacies.

I don't want to be included. What do I do?

By doing nothing, a practice that does not currently use BMJ's health analytics software will not be involved in the National Audit.

A practice that already uses Informatica's health analytics software needs to specifically opt in to the CKD Toolset to use both the Quality Improvement Tool, and provide data for the national audit.

A practice that starts the National Audit, but later decides to opt out will be able to do so through the licence management element of the BMJ software.

Do you have Ethics Approval from an Ethics Committee

This is an audit, not research, so ethics approval is not necessary. LSHTM & UCL do intend to conduct some comparative research and will follow the normal route of getting ethics committee approval, and applying for Data Access through the normal process defined by HQIP [see here]

What data does secondary/acute care providers need to provide to the audit?

None, all data from secondary care will be extracted via Hospital Episodes Statistics.

Will secondary care be involved?

Secondary care are not directly involved, though we will be accessing secondary care data through the Hospital Episodes Statistics data. There will however be a small scale survey within the National audit to understand renal units interfaces with primary care.

How can I adjust the Prompts?

You can adjust the prompts in various ways, from full suppression to presentation of additional ones to guide your decision making. To do this, go to your BMJ software settings and select the prompts tab. Select HQIP CKD and you will be presented with the available prompts for that audit displayed in groups. By double clicking on a group you will be shown the prompts available. Clicking on a prompt and selecting enable will make the prompt active; selecting disable will turn it off.

Why do you recalculate my eGFR values?

The NCKDA has identified several issues around the reported eGFR that impact on the calculation of audit outcome measures and the delivery of electronic quality improvement. These include the availability of numeric eGFR measurements (i.e. not <15 or >90), ethnicity-adjustment, laboratory calibration and the introduction of new estimating equations.  As a consequence we are recalculating all eGFR values so that there is a 'level playing field' across all sites.

A paper with more detail on this issue is available here.