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Screening patients with hypertension as well as those with diabetes can lead to the early identification of chronic kidney disease (CKD) and should be included in the quality framework, say GPs.

It could save lives by preventing the late referral of patients with CKD as well as helping to reduce healthcare costs and the burden of kidney disease.

The call comes as findings from a Norwegian study, published in the BMJ, have shown that screening patients with diabetes and hypertension is the most effective strategy to detect patients with CKD.

Professor Mike Kirby, Hertfordshire GP and member of the Primary Care Cardiovascular Society, said: ‘GPs should test patients with hypertension for CKD and this should be included in the quality framework as a lot of patients with hypertension will get renal damage.’
 
Although there is no requirement for CKD screening of hypertensives in the quality framework, he added that: ‘Most hypertension patients with high creatinine levels will be checked for estimated glomerular filtration rate and then included in the CKD register.’

Dr Ian Wilkinson, GPSI in renal medicine in Oldham, Lancashire, said that the hypertension register was routinely tested for CKD, but that there should be an indicator for hypertension in the framework.

The BMJ study found that the high-risk screening model of restricting screening to people with previously known hypertension or diabetes identified 44.2 per cent of all cases of CKD.

At present, screening for CKD is accepted practice in patients with hypertension or diabetes. Researchers found that the restriction detected only 51.6 per cent of cases.

However, screening that targeted people with hypertension, diabetes, or those aged over 55 identified 93.2 per cent of cases.
 
GPC negotiator Dr Richard Vautrey said there were no plans to introduce such an indicator to the framework as the work was already being done.
 
sanjay.tanday@haymarket.com
 
BMJ Online