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Chronic kidney disease: early identification and management of chronic kidney disease in adults in primary and secondary care [CG182]

Measuring the use of this guidance

Recommendation: 1.3.1

Agree the frequency of monitoring (eGFRcreatinine and ACR) with the person with, or at risk of, CKD; bear in mind that CKD is not progressive in many people. [new 2014]

What was measured: Proportion of patients on the CKD register whose notes have a record of a urine albumin:creatinine ratio (or protein:creatinine ratio) test in the preceding 12 months.
Data collection end: March 2018
37.2%
Number that met the criteria: 592940 / 1593368
Area covered: England
Source: Indicators no longer in QOF (INLIQ)


Recommendation: 1.6.1

In people with CKD aim to keep the systolic blood pressure below 140 mmHg (target range 120–139 mmHg) and the diastolic blood pressure below 90 mmHg[6].

What was measured: Patients who achieved the NICE BP control target
Data collection end: March 2010
58.1%
Number that met the criteria: 829 / 1426
Area covered: Regional
Source: Fraser SDS et al. (2013) Suboptimal blood pressure control in chronic kidney disease stage 3: baseline data from a cohort study in primary care. BMC Family Practice, Vol 14 p88

What was measured: Proportion of people with CKD stage 3 to 5 without diabetes who had a below target blood pressure reading recorded
Data collection end: June 2016
53.1%
Area covered: England and Wales
Source: National Chronic Kidney Disease Audit.

What was measured: Proportion of patients on the CKD register in whom the last blood pressure reading (measured in the preceding 12 months) is 140/85 mmHg or less.
Data collection end: March 2018
65.5%
Number that met the criteria: 1043942 / 1593368
Area covered: England
Source: Indicators no longer in QOF (INLIQ)


Recommendation: 1.6.2

In people with CKD and diabetes, and also in people with an ACR of 70 mg/mmol or more, aim to keep the systolic blood pressure below 130 mmHg (target range 120–129 mmHg) and the diastolic blood pressure below 80 mmHg

What was measured: Proportion of people with CKD stage 3 to 5 with diabetes who had a below target blood pressure reading recorded.
Data collection end: June 2016
29.2%
Area covered: England and Wales
Source: National Chronic Kidney Disease Audit.


Recommendation: 1.6.3

Offer a low‑cost renin–angiotensin system antagonist to people with CKD and: - diabetes and an ACR of 3 mg/mmol or more (ACR category A2 or A3) - hypertension and an ACR of 30 mg/mmol or more (ACR category A3) - an ACR of 70 mg/mmol or more (irrespective of hypertension or cardiovascular disease)[4]. [new 2014]

What was measured: Proportion of patients on the CKD register with hypertension and proteinuria who are currently treated with an ACE-I or ARB.
Data collection end: March 2015
76.4%
Area covered: England
Source: Health and Social Care Information Centre. Quality Outcomes Framework.

What was measured: Proportion of patients on the CKD register with hypertension and proteinuria who are currently treated with renin-angiotensin system antagonists.
Data collection end: March 2018
70.5%
Number that met the criteria: 91904 / 130280
Area covered: England
Source: Indicators no longer in QOF (INLIQ)



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