Abstract
Background: In March 2006, evidence-based guidelines for the management of chronic kidney disease (CKD) in adults in the UK were published including the recommendation that kidney function should be assessed by formula-based estimation of glomerular filtration rate (eGFR), using the 4-variable modification of diet in renal disease (MDRD) equation. The purpose of this study was to evaluate whether or not improved assessment of renal function by eGFR reporting followed by an intensive local education programme and local protocols affected the prevalence of renal anaemia at the time of starting dialysis for the first time. Methods: To do this, we collected data on haemoglobin levels in people starting renal replacement therapy (RRT) for the first time, during the 12 months immediately preceding eGFR reporting. We collected data for a further 12 months after eGFR was introduced; starting 6 months after the official date of introduction. Results: The proportion of people with Haemoglobin (Hb) levels ≥ 11 g/dl increased from 25.4% in the pre-eGFR era to 41.1% in the post eGFR era. In addition, average Hb levels were better in the post eGFR era (9.89 vs. 10.2 g/dl) although this did not reach statistically significance. In general, in the post eGFR era, people known to the renal services for less than 1 month prior to starting RRT had the worst Hb levels (8.7 g/dl). Hb levels were higher according to time of referral prior to RRT with peak Hb levels in people referred 6 - 9 months (11.5 g/dl) beforehand. Conclusions: It has been suggested that estimated GFR reporting may be associated with earlier recognition of kidney disease. This may have contributed to the increase in the proportion of people with optimal haemoglobin (≥11 g/dl) levels prior to starting renal replacement therapy. However a large number still start renal replacement therapy with severe anaemia. The increase in Hb levels in the post eGFR era could also result from better anaemia care which could be an effect of other guideline implementation.
Highlights
In March 2006, evidence-based guidelines for the management of chronic kidney disease (CKD) in adults in the UK were published including the recommendation that kidney function should be assessed by formula-based estimation of glomerular filtration rate, using the 4-variable modification of diet in renal disease (MDRD) equation
The purpose of this study was to evaluate whether or not improved assessment of renal function by estimation of glomerular filtration rate (eGFR) reporting followed by an intensive local education programme and local protocols affected the prevalence of renal anaemia at the time of starting dialysis for the first time
Because of the difficulty getting reliable laboratory data on patients started on treatment elsewhere, further analysis was limited to people started on renal replacement therapy (RRT) locally in the year prior to eGFR reporting (n = 79) and in the year afterwards following the 6 months watershed period (n = 92)
Summary
In March 2006, evidence-based guidelines for the management of chronic kidney disease (CKD) in adults in the UK were published including the recommendation that kidney function should be assessed by formula-based estimation of glomerular filtration rate (eGFR), using the 4-variable modification of diet in renal disease (MDRD) equation. Methods: To do this, we collected data on haemoglobin levels in people starting renal replacement therapy (RRT) for the first time, during the 12 months immediately preceding eGFR reporting. In the post eGFR era, people known to the renal services for less than 1 month prior to starting RRT had the worst Hb levels (8.7 g/dl). Conclusions: It has been suggested that estimated GFR reporting may be associated with earlier recognition of kidney disease This may have contributed to the increase in the proportion of people with optimal haemoglobin (≥11 g/dl) levels prior to starting renal replacement therapy. The manner in which endogenously produced solutes are removed by the kidney including creatinine and cystatin C may be used to estimate GFR [1] These techniques are cumbersome and impractical in routine clinical practice. These formulas tend to be based on height, length, weight and serum creatinine levels [3,4]
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