The role of primary care in managing chronic kidney disease

Brady, Mark E.; O’Donoghue, Dónal

doi:10.3399/bjgp10x502065

Cited by 13 publications

(6 citation statements)

References 6 publications

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“…The observed increased incidence of NF cannot therefore be explained by increased prevalence of DM. The proportion of chronic diseases predisposing to NF has been compared to that in the UK population using the QOF in General Practice which has been previously validated but may underestimate the population [26][27][28][29]. An increase in the age-standardised death rate from NF was seen in line with the observed increased incidence (Fig.…”

Section: Discussionmentioning

confidence: 99%

A 16‐year Longitudinal Cohort Study of Incidence and Bacteriology of Necrotising Fasciitis in England

et al. 2020

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Background Necrotising fasciitis (NF) is a rapidly progressive, destructive soft tissue infection with high mortality. The primary aim of this study was to evaluate the incidence and mortality of NF amongst patients admitted to English National Health Service (NHS) hospitals. The secondary aims included the identification of risk factors for mortality and causative pathogens. Methods The Hospital Episodes Statistics database identified patients with NF admitted to English NHS Trusts from 1/1/2002 to 31/12/2017. Information on patient demographics, co-morbid conditions, microbiology specimens, surgical intervention and in-hospital mortality was collected. Uni-and multivariable analyses were performed to investigate factors related to in-hospital mortality. Results A total of 11,042 patients were diagnosed with NF. Age-standardised incidence rose from 9 per million in 2002 to 21 per million in 2017 (annual percentage change = 6.9%). Incidence increased with age and was higher in men. Age-standardised mortality rate remained at 16% over the study period, while in-hospital mortality declined. On multivariable analysis, the following factors were associated with increased risk of in-hospital mortality: emergency admission, female sex, history of congestive heart failure, peripheral vascular disease, chronic kidney disease and cancer. Admission year and diabetes, which was significantly prevalent at 27%, were not associated with increased risk of mortality. Gram-positive pathogens, particularly Staphylococci, decreased over the study period with a corresponding increase in Gram-negative pathogens, predominantly E. coli. Conclusion The incidence of NF increased markedly from 2002 to 2017 although in-hospital mortality did not change. There was a gradual shift in the causative organisms from Gram-positive to Gram-negative.

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Section: Discussionmentioning

confidence: 99%

A 16‐year Longitudinal Cohort Study of Incidence and Bacteriology of Necrotising Fasciitis in England

et al. 2020

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“…The percentage of patients taking aspirin for cardioprotection before pharmacist intervention was high, causing a relatively low increase in aspirin use as a result of the intervention. Patients with CKD are twice as likely to die from a cardiovascular event as are patients without CKD; however, the recommendation for aspirin use in patients with CKD before dialysis is vague . The low rate of aspirin initiation in this intervention is likely attributable to the nonspecific recommendation for aspirin use in patients with CKD and literature highlighting a high bleeding risk with aspirin use in patients with decreased renal function …”

Section: Discussionmentioning

confidence: 99%

Pharmacist‐Driven Renal Medication Dosing Intervention in a Primary Care Patient‐Centered Medical Home

et al. 2014

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“…Brady and O’Donoghue [ 27 ] also described wide variation in documented CKD prevalence between practices, which could not be explained by practice characteristics or demographic data. Crinson et al.…”

Section: Discussionmentioning

confidence: 99%

Recording blood pressure and eGFR in primary care after the Belgrade screening study

et al. 2018

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Background: In 2009, Belgrade nephrologists and general practitioners from thirteen health centers carried out screening for chronic kidney disease (CKD). Three years later, medical records of patients from four health centers participating in the screening study were retrospectively analyzed in order to check whether general practitioners had continued to control patients at risk for CKD in accordance with the recommendations provided.Methods: The study included 460 patients who visited their doctor at least once in the three-year period. Data on blood pressure, ACEI use, estimated glomerular filtration rate (eGFR) and comorbidities were taken from patients’ medical records.Results: Blood pressure was not recorded in any of the three years in 42.8% and eGFR in 36.7% of the patients, but blood pressure was registered every year in 7.8% and eGFR in 4.3% of them. Over the three years, the relative number of patients with recorded blood pressure decreased from 41.7% to 17.8%, and with recorded eGFR from 41.7% to 21.5%. Multivariate linear regression found that Health Center, systolic and diastolic blood pressure and presence of hypertension were negatively associated with number of years with recorded blood pressure. Health Center, systolic blood pressure and sum of years with recorded eGFR below 60 ml/min/1.73m2 were associated with number of years with recorded eGFR.Conclusions: Under-recording of blood pressure and eGFR in primary care health centers suggests lack of adherence to current guidelines and insufficient care of CKD patients. This implies the necessity for continuous education of physicians.

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The role of primary care in managing chronic kidney disease

Cited by 13 publications

References 6 publications

A 16‐year Longitudinal Cohort Study of Incidence and Bacteriology of Necrotising Fasciitis in England

A 16‐year Longitudinal Cohort Study of Incidence and Bacteriology of Necrotising Fasciitis in England

Pharmacist‐Driven Renal Medication Dosing Intervention in a Primary Care Patient‐Centered Medical Home

Recording blood pressure and eGFR in primary care after the Belgrade screening study

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