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Association between practice coding of chronic kidney disease (CKD) in primary care and subsequent hospitalisations and death: a cohort analysis using national audit data

Published version
Peer-reviewed

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Authors

Kim, Lois 
Prieto-Merino, David 
Wheeler, David 
Steenkamp, Retha 

Abstract

jats:secjats:titleObjective</jats:title>jats:pTo examine the association between practice percentage coding of chronic kidney disease (CKD) in primary care with risk of subsequent hospitalisations and death.</jats:p></jats:sec>jats:secjats:titleDesign</jats:title>jats:pRetrospective cohort study using linked electronic healthcare records.</jats:p></jats:sec>jats:secjats:titleSetting</jats:title>jats:p637 general practitioner (GP) practices in England.</jats:p></jats:sec>jats:secjats:titleParticipants</jats:title>jats:p167 208 patients with CKD stages 3–5 identified by 2 measures of estimated glomerular filtration rate <60 mL/min/1.73 mjats:sup2</jats:sup>, separated by at least 90 days, excluding those with coded initiation of renal replacement therapy.</jats:p></jats:sec>jats:secjats:titleMain outcome measures</jats:title>jats:pHospitalisations with cardiovascular (CV) events, heart failure (HF), acute kidney injury (AKI) and all-cause mortality</jats:p></jats:sec>jats:secjats:titleResults</jats:title>jats:pParticipants were followed for (median) 3.8 years for hospital outcomes and 4.3 years for deaths. Rates of hospitalisations with CV events and HF were lower in practices with higher percentage CKD coding. Trends of a small reduction in AKI but no substantial change in rate of deaths were also observed as CKD coding increased. Compared with patients in the median performing practice (74% coded), patients in practices coding 55% of CKD cases had a higher rate of CV hospitalisations (HR 1.061 (95% CI 1.015 to 1.109)) and HF hospitalisations (HR 1.097 (95% CI 1.013 to 1.187)) and patients in practices coding 88% of CKD cases had a reduced rate of CV hospitalisations (HR 0.957 (95% CI 0.920 to 0.996)) and HF hospitalisations (HR 0.918 (95% CI 0.855 to 0.985)). We estimate that 9.0% of CV hospitalisations and 16.0% of HF hospitalisations could be prevented by improving practice CKD coding from 55% to 88%. Prescription of antihypertensives was the most dominant predictor of a reduction in hospitalisation rates for patients with CKD, followed by albuminuria testing and use of statins.</jats:p></jats:sec>jats:secjats:titleConclusions</jats:title>jats:pHigher levels of CKD coding by GP practices were associated with lower rates of CV and HF events, which may be driven by increased use of antihypertensives and regular albuminuria testing, although residual confounding cannot be ruled out.</jats:p></jats:sec>

Description

Peer reviewed: True

Keywords

Renal medicine, 1506, 1728, Chronic renal failure, EPIDEMIOLOGY, PRIMARY CARE, PUBLIC HEALTH, Quality in health care

Journal Title

BMJ Open

Conference Name

Journal ISSN

2044-6055
2044-6055

Volume Title

Publisher

BMJ
Sponsorship
MRC (MR/N013638/1)