Early detection of chronic kidney disease

BMJ 2008; 337 doi: (Published 01 October 2008) Cite this as: BMJ 2008;337:a1618
  1. J Feehally, consultant nephrologist1,
  2. K E Griffith, general practitioner2,
  3. E J Lamb, consultant clinical scientist3,
  4. D J O’Donoghue, national clinical director for kidney care for England45,
  5. C R V Tomson, consultant nephrologist6
  1. 1University Hospitals of Leicester NHS Trust, Leicester LE5 4PW
  2. 2Wenlock Terrace Surgery, York
  3. 3East Kent Hospitals NHS Trust, Canterbury
  4. 4Department of Health, London
  5. 5Salford Royal Hospitals Foundation Trust, Salford
  6. 6North Bristol Hospitals NHS Trust, Bristol
  1. Correspondence to: J Feehally jf27{at}
  • Accepted 6 July 2008

J Feehally and colleagues explain the value of reporting estimated glomerular filtration rate

as part of a comprehensive management

programme for chronic kidney disease

The number of patients receiving long term renal replacement therapy in the United Kingdom is growing inexorably and treatment already consumes more than 2% of the total NHS budget. The cost of managing patients who present late in the course of progressive chronic kidney disease, the evidence that progression can be slowed or halted, and evidence that chronic kidney disease is associated with increased risk of cardiovascular disease have focused attention on how to optimise the management of early disease in primary care. Policies and guidelines have been designed to improve the recognition, management, and referral of patients with chronic kidney disease by non-specialists. However, the routine laboratory estimation of glomerular filtration rate (GFR) using the simplified modification of diet in renal disease (MDRD) equation has proved controversial.1 Here we describe the UK policies on identifying and managing chronic kidney disease and address some of the concerns about estimating GFR.

Strategic purpose of estimating GFR

The NHS leads the world in the development of a coherent strategy to improve the quality of care for people with chronic kidney disease. The national service framework for renal services for England was introduced in response to recognition of the growth (and cost) of the treatment of established renal failure.2 3 Renal replacement therapy costs around £30 000 (€37 000; $53 000) a year for each patient, and late referral may cost a further £15 000. The framework adopted a five stage classification of chronic kidney disease based in part on GFR and recommended systematic monitoring of kidney function in at risk populations—those with hypertension, diabetes, vascular disease, urological abnormalities, a family history of kidney disease, or taking drugs that can affect kidney function.

UK consensus guidelines …

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