The National CKD Audit: a primary care condition that deserves more attention

Chronic kidney disease (CKD) is a common condition, with an estimated prevalence in the UK of around 5–7%, and a GP recorded prevalence in the England Quality and Outcomes Framework (QOF) in 2017 of 4. 1%, 3 which is higher than the prevalence of coronary heart disease. majority of people with CKD are detected and managed in primary care rather than by kidney specialists. Early identification in primary care, particularly among populations with risk factors such as diabetes and hypertension, enables appropriate management of blood pressure, cardiovascular risk and lifestyle factors. There is evidence that progression of CKD can be delayed by such interventions, and that implementation of these interventions can be improved by use of quality improvement tools in primary care. CKD as a long-term condition has not had an easy ride. Since its definition in 2002 there have been concerns about overdiagnosis, described as ‘when people without symptoms are diagnosed with a disease that ultimately will not cause them symptoms or early death’, and anxieties about the disclosure of early-stage CKD to patients, along with the work of reassurance and increased monitoring that this might entail. This debate within general practice has left some practitioners uncertain about the importance of naming, coding and managing CKD in primary care.