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Title: Defining chronic kidney disease stage 3 in primary care
Author: McIntyre, Natasha J.
Awarding Body: University of Nottingham
Current Institution: University of Nottingham
Date of Award: 2012
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Background and objectives: The majority of patients with chronic kidney disease (1) stage 3 are managed in non-specialist centres but most studies of CKD are conducted in Nephrology Departments in secondary care. Moreover, subjects ~75 years, which make up a large proportion, are often excluded. We undertook a detailed prospective study of unselected patients in primary care to fill the knowledge gap regarding CKD stage 3 and to identify factors that may be independent determinants of cardiovascular disease (CVO) and progressive CKD in this setting. Design, setting, participants and measurements: Subjects with eGFR 59- 30mUmin/1.73m2 were recruited from 32 Primary Care Practices. Medical history and demographic data were obtained and participants underwent clinical assessment including blood pressure, anthropomorphic measurements, skin autofluorescence (AF) and pulse wave velocity (PWV) as well as extensive urine and serum biochemistry. Results: 1741 participants were included: mean age 72.9±9 yrs; 60% (n=1052) female; 97.5% (n=1698) white; 17% (n=294) diabetic. Mean eGFR was 52.5±10mLs/min/1. 73m2 and 16.9% had microalbuminuria or more severe proteinuria. 77% had CKD stage 3A and 64.5% (n=1123) received RAASi treatment. 22.2% (n=387) had a history of cardiovascular events and 55% (n=950) were past or current smokers. Analysis identified participants with CKD stage 38, diabetes and age "275 years evidencing a higher risk profile for CKD progression and cardiovascular events than people with CKD stage 3A, those without diabetes or participants <75 years. 67% of participants required further medical intervention following their study feedback. Most required improved control of hypertension (n=576, 33 .1% of cohort). Less than 6% of participants met NICE criteria for referral to nephrology services. 41 % were unaware of their CKD diagnosis. Subjects with formal educational qualifications, age <75years, eGFR 30-44mUmin!1 .73m2 and significant albuminuria were identified as more likely to be aware of their diagnosis. Analysis of skin AF and PVVV readings revealed significant correlations with several potential risk factors for cardiovascular disease (CVO) and progression of CKD. Conclusion: The RRID study provides unique insights into patients with CKO stage 3 in primary care. Clinical characteristics are distinct from subjects generally seen in Nephrology Departments. Follow up over 10 years will assess the predictive value of a wide range of risk factors and yield valuable data complementary to that derived from studies conducted in secondary care.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available