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Information to support eGFR reporting
Published alongside the UK CKD eGuide on the Renal Association website
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Published alongside the UK CKD eGuide on the Renal Association website
eGFR (estimated Glomerular Filtration Rate) reporting is seen as a key element in achieving earlier detection of serious CKD, and early institution of preventive measures. The UK CKD guidelines (2005) and many other guidelines internationally support the general introduction of eGFR reporting.
Introduction of eGFR reporting is likely to lead to many extra patients being identified as having CKD, especially in older age groups. It is widely agreed that it both unfeasible and unnecessary that all of these should be referred to nephrologists. The UK CKD guidelines support the management of most patients with moderate GFR reduction (down to 30mls/min/1.73m2 if stable, and with low levels of urinary protein/blood) in the community. This page accommodates discussions and resources to support the introduction of eGFR reporting in the UK.
Resources and Implementation Experience
Background and Resources
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Topic
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Description
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| MEDICAL INFO National leaflet for patients (pdf 560kb, added Jan 2007) National leaflet for GPs (updated September 2007) (pdf); DoH documents: Info for GPs; and info for labs; and eGFR FAQs (all Word docs from the DoH); covering letter to GPs (pdf) ... see also these existing resources The eCKD guide on this website, and www.renal.org/eGFR - link for results forms |
The National Leaflets were funded by the Association of Renal Industries. The eGFR leaflet was distributed to GPs and clinical directors of renal units from April 2006, patient leaflet Jan 2007. Further copies from info@ari-uk.net . DoH info was agreed by the Renal Advisory Group to send to all GPs and labs in England. Copies sent to the devolved administrations. As the GMS contract is UK-wide, eGFR reporting is expected to be introduced simultaneously throughout the UK (see immediately below). The eCKD guide is adapted from the full UK CKD guidelines to provide information in a "what I need to know right now" format. |
| QOF - presentation by Steve Blades (40kb ppt file) Read codes for CKD from the Clinical Service page |
Points for management of CKD make eGFR reporting essential from April 2006. Further info from the Clinical Service page. |
| PATIENT INFO Patient info leaflet (Steve Blades; .doc) NKF webpage (Rob Higgins) EdREN on CKD |
Some of the poster presentations below also include or point to patient information resources. |
| WHICH EQUATION ? Implementation of eGFR in UK (.ppt file). DoH advice to labs (.doc) From the USA's NKDEP, suggestions for laboratories and technical info on using creatinine to estimate GFR, with info on the two equations. Our online calculator now carries a caution. |
A variant on the original MDRD equation will be used for general implementation. It (1) uses a different constant (175 not 186) for creatinine assays that give 'perfect' measures of creatinine (the original MDRD assays didn't); and (2) will introduce a local factor designed to relate local assays to gold-standard creatinine assays. Creatinines will therefore continue to vary between centres, but eGFRs should be more consistent. Note that the general imprecision of the estimation of eGFR for any one individual is little affected by this change - but it should mean that identification of reduced GFR in different laboratories is not systematically distorted by local variations in assays. |
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Where
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Information
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| Heartlands experience (2Mb ppt file) | Heartlands implemented eGFR reporting in 2004 - reporting of impact on referrals and service. |
| Newry experience (90kb ppt file) | Identification of stage 4 patients in the community in 2001 found only 10% required RRT in 5 years; a policy of discharging many stage 4 patients to shared care is described. |
| Edinburgh and Lothian experience (900kb ppt file) | Implemented Jan 2006. |
| St Helier experience (1.1Mb ppt file) | Implemented Feb 2006. |
| Ayrshire plan | Includes proposal for linking and sharing data between primary and secondary care. |
| East Midlands plan (2.5Mb ppt file) | Describing a broader education programme prior to implementation. |
| Scotland (60kb ppt file) | Proposals for implementation in Scotland. |
Presentations from eGFR meeting October 2005
On 4th October 2005 Dr Stuart Rodger (chair of the Clinical Service Committee) organised a meeting to discuss issues arising from the introduction of GFR reporting. The meeting was instigated by John Scoble, funded by the Guys Modernisation Project and the programme committee were Donal O'Donoghue, Lawrence Goldberg, Kevin Harris, Ian John and Stuart Rodger. Also included (not presented at the meeting) are slides from Neil Turner and Steve Blades on the eCKD guideline development.
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Title
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Speaker
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Summary
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| Laboratory issues | Dr Ed Lamb (clinical biochemist East Kent Hospital) | Formulae for eGFR and the MDRD 4 method. Problems of interpreting eGFR in the elderly. (.ppt file 2.1Mb) |
| Kaiser experience of GFR implementation 1 | Dr Peter Crooks (Kaiser Permanente) | Implementation issues in Southern California (.ppt file 700kb) |
| Kaiser Permanente experience 2 | Dr Jim Dudl (Kaiser Permanente) | Experience with prevention in the Kaiser programme (.ppt file 200kb) |
| Private sector involvement in a CKD project | Dr Nick Richards (Medical Director Optimal Medical Care) | Described a Lincolnshire project using eGFR to identify and manage patients in primary care with CKD. Resistance of some GPs to engage was highlighted. (.ppt file 540kb) |
| Primary care perspectives 1 | Dr David Colin-Thome (National Clinical Director for Primary Care) | Described current policies in primary care, especially management of long-term conditions. How CKD fits into this model; impact of possible future renal QOFs (decision in November). Need for greater awareness in patients and public about CKD, and for better links between primary and secondary care. (.ppt file 90kb) |
| Primary care 2 | Dr Tony Snell (Medical Director, Birmingham and the Black Country SHA) | Outlined the future shaping of primary care, the current GP contract and the QOF system. He provided an analysis of local QOF data and discussed possible QOFs for CKD. (.ppt file 1Mb) |
| Secondary care perspective | Dr Lawrence Goldberg (Consultant Nephrologist, Brighton) | Need for appropriate local guidelines. Decision making regarding further investigation; potential patient pathways between primary care and renal units. Need to improve IT links. Changes in outpatient nephrology practice that might be expected. (.ppt file 160kb) |
| Role of the specialist nurse | Ms Nikki Thomas (Research Lead Nurse, St Helier's Hospital) | Role of the specialist renal nurse in the community. Examples of improved education with both patients and the primary care team. Highlighted the CKD Forum for renal nurses. (.ppt file 5Mb) |
| Educational support for primary care | Dr Roger Gadsby (Senior Lecturer in Primary Care, University of Warwick) | Described the certificate in diabetes care course which he has lead, taken by over 5000 people, mostly GPs and Practice nurses. Potential value of a CKD module and how this might be developed. (.ppt file 300kb) |
| Added later ... | ||
| Online support for eGFR reporting | Neil Turner (Edinburgh) | Existing, 'in progress', and future possibilities. (.ppt file 1.4Mb) See also the next box on this page |
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Published on the Renal Association website
This page created October 2005, modified