Tool to help GPs predict which kidney patients need hospital care added to NICE chronic kidney disease guideline
We are delighted to share that a study we funded that discovered a way to help GPs predict which patients with chronic kidney disease (CKD) are more likely to need dialysis or a kidney transplant in the future has directly led to changes in the NICE CKD guidelines, which were updated last week.
A tool to predict risk of kidney failure
In the study, which we funded alongside the NIHR Applied Research Collaborations East Midlands, Dr Rupert Major and his team from the University of Leicester modified and tested a tool called the Kidney Failure Risk Equation (KFRE).
This is an equation that uses data collected from patients with CKD, including estimated glomerular filtration rate (eGFR: a test to calculate how well a patient’s kidneys are working), the amount of protein in the patient’s urine, their age and their gender, to predict their risk of developing kidney failure within 2 and 5 years. The results are then given as a percentage.
The updated guideline
Using the data from this study, Rupert and our friends at the UK Kidney Association have supported and promoted a change to the NICE CKD guideline – clinical guidelines on how healthcare professionals should care for people with specific conditions – to use the KFRE when referring patients to kidney specialists.
While previously, GPs would refer patients to hospital based on their eGFR, which tells you how well the kidneys are working, the updated guideline recommends that GPs now use the KFRE and refer patients to a kidney specialist if they have a 5% or higher risk of needing dialysis or transplant in the next 5 years.
Why is predicting risk helpful?
Having a tool to accurately predict a patient’s risk of developing kidney failure will help both doctors and patients plan the best possible pathway of care. It will highlight which patients need to be referred to hospital because their kidney disease is more serious, and who can be cared for by their GP.
“I believe it will empower patients to understand their risk of their kidney disease progressing and in turn identify ways that they can reduce this risk. It will also aid clinicians in communicating risk.” explains Rupert. “One of the many findings of the study, was that it may also reduce the number of referrals to hospital kidney specialists without affecting the number of cases detected of people needing dialysis or a transplant.”
A positive step towards more personalised care
Better information about a patient’s risk of developing kidney failure allows both patients and healthcare providers to be prepared and to make the best possible treatment decisions for each specific individual.
“As clinicians, knowing an individual’s percentage risk for needing dialysis or transplantation allows us to have a more personalised discussion with patients about referral to see a kidney specialist, timing of referral for dialysis fistula formation and many other aspects of care.” Rupert explains. “It opens the discussion, what you may want for your care if your risk was 5% in the next 5 years, might be very different to what another patient would want for their care.”
Going forward, it is important that researchers continue to study KFRE, both to ensure that it continues to accurately predict risk as treatments for kidney disease improve, and to further understand how decisions are made based on its predictions.
Our research leads to changes in clinical practice
We are determined to make every piece of research that we fund count for patients, and we are proud that this work will now directly benefit people with kidney disease.
“The studies I completed as part of my fellowship funded by Kidney Research UK were used to test and modify the KFRE.” Rupert explains. “Without the funding I would not have been able to complete the work that was published in November 2019 and led to this major change in the NICE-CKD guidelines published recently.”
Dr Aisling McMahon, executive director of research, innovation and policy at Kidney Research UK, said, “We are thrilled to see that Rupert’s work has led to these important changes in the NICE CKD guidelines and will make a real difference in the personalised care of people with kidney disease.”
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