O07 MAKING THE MOST OF NEPHROLOGY CLINICS: 
EGFR AN INTUITIVE METHOD OF ASSESSING PROGRESSION AND REGRESSION OF CHRONIC KIDNEY DISEASE (CKD).A. Rainey1, M. Quinn*2, K. J. Cairns1, A. H. Marshall1, F. Kee3, G. Savage3, D. Fogarty2
1Centre for Statistical Science and Operational Research, 2Department of Nephrology, 3Department of Epidemiology, Queen's University, Belfast, United Kingdom
Introduction:
The number of patients receiving renal replacement therapy in the UK is
rising rapidly, costing over 2% of the total NHS budget. The Renal
Association have published referral guidelines for CKD re-emphasising
the importance of assessing patients with progressive CKD at Nephrology
outpatients.
Aims:
In the light of current guidelines; to investigate if the assessment
and referral of patients is appropriate based on the progressive risk
of CKD.
Methods:
In Northern Ireland 2,892,340 creatinine samples from 1st Jan 2001 -
31st Dec 2002 were extracted from regional laboratories. Merging these
to an enriched General Practice dataset produced a cohort of 75,434
subjects containing 307,663 results. To capture progression over the
two-year period, a three-point assessment was devised. Progression and
periods of regression were characterised by the gradients ∆A and ∆B. A
cut-off level (eGFR 60mls/min) was additionally used to categorise the
change in patient’s eGFR. Progression was also categorised as stable
(<1mls/min/yr), slow (1-5mls/min/yr) and rapid (>5mls/min/yr).
Results:
56,356 (74.7%) subjects had ‘all eGFR results’>60 throughout the
entire period, 11,249 (14.9%) had ‘all eGFR results’<60 and 5017
(6.7%) had a minimum eGFR measured below 60mls/min and yet subsequently
improved having a value measured above 60mls/min. In total, 1,167 of
the 75,434 subjects were known to Nephrology services. Of these, 341
(29.2%) had an eGFR>60mls/min over the two year period. Importantly
2,699 (3.6%) subjects demonstrated a rapid decline from stages 1 or 2
CKD to stage 3 or worse, of which 2,627 (97.3%) were unknown to
Nephrology.
Conclusions:
Progression of CKD is often taught to be linear; this data indicates
that alternative patterns of progression occur in the natural history
of CKD, including improvement in function. Significant numbers of
subjects attending Nephrology services have no evidence of progressive
decline in eGFR whilst the vast majority with CKD remain unseen.
Although some of these patients may have important reasons for
attending Nephrology services, this may be to the detriment of those
with more progressive CKD.
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