Five percent of the Dutch population is aware of chronic kidney damage (CNS), based on GP records. Monitoring in general practice of patients with CNS has improved in recent years: in 62% of them, kidney function, blood sugar levels and blood pressure are checked annually; in 2013 this still happened to 43%. Patients who have another condition in addition to CNS, such as diabetes or high blood pressure, are best monitored. This is apparent from research by Nivel on behalf of the Kidney Foundation. Monitoring by the GP is important because treatment according to the NHG guidelines can delay further deterioration and prevent complications such as cardiovascular disease.
Registration in patient files could be better
General practitioners register the diagnosis of CNS in 2.5% of their adult patients in the
GP file. In addition, another 2.4% of the patients has a reduced kidney function without the GP having properly registered the diagnosis of CNS. For proper treatment and medication monitoring of patients with CNS, it is important that the diagnosis is correctly recorded in the file. So there is room for improvement.
NHG guidelines better followed in people who have diabetes or high blood pressure in addition to CNS
An important indicator to see whether patients with CNS are monitored according to the NHG guidelines is the annual check-up of kidney function, blood sugar and blood pressure. This is checked annually in 62% of all patients with CNS. In previous research from 2013, this still happened at 43%. Of the patients who have CNS without another condition, kidney function, blood sugar and blood pressure are checked annually in 38%. Patients with diabetes in addition to CNS are best monitored according to this indicator (77%), followed by patients with CNS and high blood pressure (65%) and patients with CNS and cardiovascular disease (64%).
It therefore seems that people with CNS who receive integrated care have a better picture. This may be related to the fact that within integrated care the checks by the practice nurse of the general practitioner are carried out according to a fixed protocol. It may therefore be advisable to have the monitoring and the accompanying checkups also in patients with only CNS – i.e. without co-morbidities such as cardiovascular disease or diabetes – take place via the practice nurse. This person can regularly call the patient for a check of the kidney function and give lifestyle advice.
Giving lifestyle advice can be improved
An important part of the NHG guidelines for the treatment of patients with CNS is the provision of lifestyle advice. In 40% of the patients with CNS, the general practitioner indicated in the patient file that these lifestyle advice had indeed been given. Here too improvement seems possible.
Medication monitoring appears to be in order, deviation from the guideline may be well-considered
The medication prescriptions for people with CNS and a comorbidity are in the vast majority of cases in accordance with the advice in the NHG guidelines. For example, more than 90% of patients with CNS and high blood pressure are prescribed antihypertensive drugs and three quarters of patients with CNS and high cholesterol are prescribed a cholesterol lowering agent.
100 percent adherence to the NHG guidelines when prescribing medication is not to be expected and general practitioners can make a well-considered choice. For example, anti-inflammatory painkillers (NSAIDs) should not be prescribed according to the guideline, but this still happens in patients with a milder form of CNS (in 15%). GPs may prescribe short-term NSAIDs for them when pain relief outweighs a possible worsening of kidney function, and when other analgesics are not an option or have insufficient effect.
About the research
Nivel investigated to what extent general practitioners comply with the NHG standard ‘Chronic kidney damage’ in patients with CNS and, in case of multimorbidity, also the NHG standards ‘Cardiovascular risk management’ (CVRM) and ‘Diabetes Mellitus type 2’. We used healthcare data from Nivel Zorgregistraties Eerste Lijn, a registration system that contains, among other things, the healthcare data that affiliated GP practices routinely record in the electronic files of their patients. In this study, data was used for the period 2017-2019 from 404 affiliated general practices.