Background

Founded in 1961, Kidney Research UK (formerly the National Kidney Research Fund) is the largest funder of research into the prevention, treatment and management of kidney disease. Our mission is to improve the quality of life of those with kidney disorders and to increase public awareness of kidney health.

We support the need for early detection and prevention in tackling the onset of kidney disease, particularly among "at risk" groups such as those with diabetes and cardiovascular disease, or from ethnic minorities. By diagnosing and treating kidney disease at an early stage, the likelihood of established renal failure is reduced, and therefore the need for transplantation or lifelong dialysis treatment.

QoF Indicators for Chronic Kidney Disease (CKD)

The QoF was originally introduced as part of the new GP contract in April 2004 to reward GP practices for delivering quality care. Indicators of quality for a range of disease areas are included, covering clinical, organisational and patient experience standards, and each has a number of points that GPs can collect, which attract a defined amount of money for the practice.

The QoF indicators for CKD call upon GPs to set up a practice register of people over 18 with Stages 3-5 of the disease, based on a test of their estimated GFR. Patients with stages 3-5 CKD, account for around 5% of the population The register is designed to be used to identify these patients, so that they receive appropriate treatment to prevent the progression of their condition and for complications of CKD.

The QoF also calls for the register to show the percentage of patients whose medical notes have a record of blood pressure in the previous 15 months, and in addition, to highlight those whose blood pressure measured 140/85 or less. Reducing blood pressure delays the progression of CKD.

Another CKD indicator required for the knowledge of the percentage of patients with high blood pressure who are being treated with either ACE (angiotensin converting enzyme) inhibitors or ARBs (Angiotensin Receptor Blockers), which are considered more effective than other anti-hypertensive drugs in reducing progression.

We are keen to encourage GPs to adopt the QoF to improve testing for CKD, increase the rate of early detection and prevention of progression.. This will require educating GPs in identifying "at risk" patients, diagnosing CKD, by the eGFR, and the steps they need to take to prevent progression of the disease.

This places greater pressure to implement the Renal NSF GPs who will need support to meet the QoF indicators, and to identify a clear patient pathway to enable timely referral of patients to secondary care. We hope that the National Institute for Health and Clinical Excellence's (NICE) forthcoming clinical guideline on CKD will also help to address these challenges and provide guidance on best practice for GPs in meeting them.

Kidney Research UK

April 2007