Test for Kidney Disease is under-prescribed suggests Report

New research led by the University of Glasgow, assessed patient data from across the UK and found that a simple blood and urine test, which can identify those most at risk of severe complications of chronic kidney disease, was not routinely being given as part of recommended investigations. The study results have prompted renewed calls from kidney specialists to encourage more patients to be given access to this test.

A common condition, affecting around 10-15% of the general population, kidney disease rarely displays symptoms in the early stages with many unaware of the condition. It can affect anyone, although the research supported other findings that it is often associated with getting older and is more common in people who are black or of south Asian origin.

Only a very small number of people (1 to 4%) with chronic kidney disease will progress to kidney failure; however testing could help GP’s identify more high-risk people and refer them to nephrologists in hospital who may be able to slow patients’ disease progression, or prepare them for dialysis or transplantation, ultimately saving lives.

While the 2021 NICE (National Institute for Health and Care Excellence) guidelines on chronic kidney disease recommended the use of the Kidney Failure Risk Equation (KFRE) for anybody with chronic kidney disease stage 3 or worse, this study found that the KFRE test, which includes measurement of protein in the urine (albuminuria), is only probably performed yearly in around 20-25% of people with chronic kidney disease.

University of Glasgow researcher and a NHS kidney specialist, Dr Jennifer Lees, said: “Kidney disease is common amongst adults, but only a small number of people need to see kidney specialists. It is important that all people with kidney disease receive the right treatments at the right time and these blood and urine tests are an easy way to ensure this happens. Our research shows that at present, not enough people with kidney disease have their urine tested and therefore may be missing out on the best treatments.”

Dr Michael Sullivan, from the University of Glasgow’s School of Cardiovascular and Metabolic Health, said: “GPs need to identify which patients will benefit most from referral to hospital clinics. The KFRE is effective at helping GPs identify and refer these patients early, before kidney disease becomes more advanced. More patients with kidney disease need to have access to this new tool. Our research shows that for this to be possible, more patients need to bring urine samples to their GP.”

For this study the researchers studied more than 1.8m patients in SAIL (The Secure Anonymised Information Linkage Databank, a national data safe haven of de-identified datasets principally about the population of Wales) and around 465,000 UK Biobank participants.

The paper ‘Potential impact of NICE guidelines on referrals from primary care to nephrology’ is published in the British Journal of General Practice. The work was funded by the Medical Research Council.

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