I think one feedback point then to any group working on the next revision of the algorithm is whether the look-back could be extended to 15 months so that CKD patients on annual monitoring are not flagged - there is nothing magical about 12 months!
Plus up the availability of info via lab tests on line is a good idea.
Best wishes
Anne
Dr Anne Dawnay PhD FRCPath
Consultant Biochemist for HSL at UCLH
Clinical Lead UCLH Clinical Biochemistry & Chair UCLH POCT Committee
Tel 020 344 72954 direct dial
Date: Thu, 29 Oct 2015 09:55:08 +0000
From: "Mascall, Gary (WRH Biochemistry Medical Staff)"
<[log in to unmask]>
Subject: Re: ?AKI ?CKD patient results
Dear Anne,
That is exactly the point our GP's are raising.
For years we have let them merrily do their thing with patients with CKD3a, monitoring however often they see clinically fit. Now all of a sudden we are adding a "warning", and a number have commented that as they give patients a copy of the results, this has lead to a few anxious patients.
Yes, I can understand this if there was no previous creatinine either ever or in the past 3-5 years, but for stable CKD3a patients seen as per the old QOF, within 15 months (who thought that one up I'll never know), I can understand their comments.
It would not be a very difficult change to make to the algorithm to encompass these two scenarios, as I would doubt the patients who have triggered these concerns (usually over 75 years of age) are likely to be heavy duty weightlifters.
Kind regards,
Gary Mascall
Gary Mascall
Consultant in Clinical Biochemistry
Worcestershire Acute Hospitals NHS Trust
www.worcsacute.nhs.uk<http://www.worcsacute.nhs.uk/>
Trust email: [log in to unmask]
NHS Net email: [log in to unmask]
Tel: 01905 760760 extn 30214
[pride]
-----Original Message-----
From: ACB AKI-Detection-Algorithm [mailto:[log in to unmask]] On Behalf Of Anne Dawnay
Sent: 29 October 2015 08:58
To: [log in to unmask]
Subject: ?AKI ?CKD patient results
Hi Gary, If creatinine is long-term above the reference range and stable what is the eGFR? I would have thought likely <60 and patient has stable CKD in which case should they not be regularly monitored? Unless of course you have lots of weightlifters which is why the GP is not concerned. As Mike says, when the algorithm was developed the group decided to add this comment to all flagged creatinines with no previous in 12 months basically to highlight the two likely causes.
Best wishes
Anne
Dr Anne Dawnay PhD FRCPath
Consultant Biochemist for HSL at UCLH
Clinical Lead UCLH Clinical Biochemistry & Chair UCLH POCT Committee
Tel 020 344 72954 direct dial
Date: Thu, 29 Oct 2015 12:46:42 +0000
From: "LOPEZ BERENICE (RM1) Norfolk and Norwich University Hospital"
<[log in to unmask]>
Subject: Re: ?AKI ?CKD patient results
Hi Gary
The old QoF recommendation you refer to has been completely phased out as have most of the other CKD indicators in the 2015/16 QoF.
Below is a snapshot from the NICE CKD guidelines 2014 which recommend at least annual monitoring for the ‘stable CKDG3a’ group you refer to depending on ACR status (and past patterns of eGFR and ACR/comorbidities/changes to treatment/inter-current illness etc..).
The ?AKI/CKD flag may therefore not only improve AKI/CKD detection but also serve as ‘am I monitoring this known CKD patient at an appropriate interval?’ reminder to GPs/practice nurses particularly given the risk of CKD slipping into the collective unconscious in primary care
As for patient anxiety, perhaps labtests online should develop an information page for patients on the warnings that may be printed on UE’s results – we could then print this web address on the result. Their AKI safety alert page was pretty good (labtestsonline.org.uk/news/AKI-alert-140612/<http://labtestsonline.org.uk/news/AKI-alert-140612>)
.
Of course, some of these stable G3a patients may be re-classified to ‘G2’ by CKD-EPI but that’s another story…
Best wishes
Berenice
Dr Berenice Lopez
Consultant Chemical Pathologist (Metabolic Medicine)
Clinical Biochemistry Department
Norfolk and Norwich University Hospital
Norwich NR4 7UY
Tel: 01603 286927
Date: Thu, 29 Oct 2015 16:07:25 +0000
From: "JONES Stuart (Pathology) (RF4) BHR Hospitals"
<[log in to unmask]>
Subject: Re: ?AKI ?CKD patient results
Dear Berenice, I will raise this with the LTO editorial team and see what we can do. Ideally we could then link our information to AKI fields in GP systems / patient portals.
Stuart
Stuart Jones FRCPath | Principal Clinical Biochemist
Clinical Biochemistry
Barking, Havering and Redbridge University Hospitals NHS Trust
Technical lead | www.labtestsonline.org.uk<http://www.labtestsonline.org.uk/>
T: 0208 970 8012 | ext 8012
E: [log in to unmask] | [log in to unmask]<mailto:[log in to unmask]>
Tw: @_stuartjones
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