5 April 2012

New e-Learning for GPs: Kidney Health in General Practice

Common dilemmas for GPs in identifying, monitoring and managing individual patients with chronic kidney disease (CKD) are addressed in a new e-learning course launched this month.

Kidney Health in General Practicehas been produced by the Royal College of General Practitioners (RCGP) in partnership with NHS Kidney Care.  The course is free, subject to registration on the RCGP e-learning website.  It aims to improve the detection and management of chronic kidney disease.

Over 1.8m people in England are diagnosed with CKD stages 3-5 with estimates suggesting a further 700,000 remain undiagnosed.  Early detection and management can reduce mortality and delay the need for renal replacement therapy and associated lifestyle constraints and costs.

The e-learning is also supplemented by a short film from Dr Donal O'Donoghue, National Clinical Director for Kidney Care, in which he discusses the impact of kidney disease on the UK population and the role of the GP in managing kidney health on an individual level and at a population level.

GPs who have undertaken this e-learning will be able to:

  • Identify patients in their practice population to be screened for chronic kidney disease
  • Supporting the patient through the natural history of chronic kidney disease, from prevention, diagnosis, review and management 
  • Educate at-risk patient groups about lifestyle and other interventions to maintain their kidney health and managing their medicines to reduce risk 
  • Coordinate care with specialists for the more severely affected patients, for those with end-stage renal disease and for those at the end-of-life 
  • Detect and support the management of the health problems associated with CKD (e.g. hypertension, anaemia, renal bone disease) 
  • Lead a multidisciplinary approach to CKD diagnosis and management, educating the practice team, and establishing an organised approach within the practice 
  • Champion the development of more integrated local services and prevention programmes (e.g. through commissioning in England).

Dr Ben Riley, Medical Director for e-Learning at the RCGP, said:  “GPs have a number of important roles relating to the promotion and management of kidney health, in the consultation, in the practice team and in the local community. CKD is under-recorded in primary care and early detection and recording is essential to reduce cardiovascular events, morbidity, hospital admissions and death.  There are ways of improving the detection and recording of patients with CKD, by actively screening patients at high risk and by opportunistically testing some patients.”

“The prevention and management of CKD is also intertwined with other chronic diseases, such as diabetes, cardiovascular disease and hypertension.  It is important that GPs think of kidney health as part of providing comprehensive care to these patients.”

Beverley Matthews, Director of NHS Kidney Care, said: “CKD is common and life threatening. It has a devastating impact on people’s lives and a costly impact on NHS resources.  Prevention is important, but early diagnosis, effective treatment and integrated care are vital to reduce the risk of cardiovascular disease and to delay progression to end stage renal failure which may require dialysis or transplantation.

“GPs and their colleagues in primary care are well placed to lead the way in managing this long term condition.  I hope this new e-learning course will equip more GPs with the knowledge and skills to further improve outcomes for their patients with CKD.” 

The course takes around three hours to complete, which can be broken up in handy 20 minute sections and is freely available on the RCGP Online Learning Environment at:

Course - http://elearning.rcgp.org.uk/course/view.php?id=85
Publicly viewable information - http://elearning.rcgp.org.uk/course/info.php?id=85

FURTHER INFORMATION

RCGP Press office – 020 3188 7574/7575/7576
Out of hours: 0203 188 7659
press@rcgp.org.uk

NOTES:

  1. Chronic kidney disease (CKD) is common, often undetected and frequently exists with other conditions, such as cardiovascular disease and diabetes. It is characterised by a gradual and irreversible reduction in the physiological functions of the kidneys over a period of months and years, relating to a decrease in the number of functioning nephrons.
  2. With the introduction of estimated glomerular filtration rate (eGFR) testing across the UK, it has become apparent that mild to moderate CKD is common and monitoring in primary care is essential to identify the minority of patients who develop more advanced kidney disease.
  3. There is evidence (NICE, 2008) that prompt management and reduction of risk factors can prevent or delay the progression of CKD and the complications that result. However, due to the lack of specific symptoms, around 30% of people with advanced kidney disease are referred late to nephrology services (NICE, 2008). This results in potentially avoidable mortality, morbidity and cost—over 2% of the total NHS budget is spent on renal dialysis and transplantation for those with advanced renal failure.
  4. Early detection of CKD avoids patients ‘crash landing’ into hospital with acute kidney injury without warning, either for the patient or for secondary care physicians.
  5. Hospital based haemodialysis costs the NHS approximately £35,000 per patient per year, so avoiding this can also save significant money for the local health care system. It has been estimated that the cost of implementing national guidance could be recouped by delaying the dialysis of one patient per practice (of 10,000 patients) by just one year.
  6. The Quality and Outcomes Framework (QOF) register indicates that in 2009-10 1,817,871 adults in England had stages 3-5 CKD, a diagnosed prevalence rate of 4.3 %. It is considered likely, however, that total prevalence is higher, as there are thought to be a number of undiagnosed cases. Health Survey for England (HSE) 2009 estimated stage 3-5 CKD prevalence at 6%.

    NHS Kidney Care    , the national service improvement organisation, helps professionals and commissioners to improve every aspect care for people with long term conditions. It aims to identify and share evidence-based good practice and to support locally-led implementation, leading to better outcomes for patients and greater productivity for the NHS.

Author Biography
The lead authors for Kidney Health in General Practice are Dr Nicola Walker, a GP with an interest in chronic kidney disease (CKD) and Dr David Stephens, a GP trainer from Inverness.

Dr Walker's previous experience includes working as a Hospital Practitioner in Nephrology managing patients with CKD in secondary care. She is a Primary Care Research Fellow at the University of Leicester and has completed a Masters in Applied Health Research. She investigated the detection and management of CKD in Primary Care for her dissertation project.

Dr Stephens,qualified at Guy's Hospital, London in 1977. He trained as a GP at Guy's and Elephant and Castle. He was GP partner and trainer both in South London and then Tonbridge for over 25 years. In 2006 Dr Stephens was awarded Fellowship of the RCGP and in 2009 and 2010 worked in New Zealand attaining the Fellowship of the Royal New Zealand College of GPs.In 2008 he was on the NICE Committee which wrote the CKD Guidelines. He now works as a locum in the Highlands of Scotland living on Loch Ness.