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NICE changes guidance to cut over-diagnosis of kidney disease

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Guidelines have increased the threshold for the diagnosis of a common kidney problem in order to reduce the number of people who are being unnecessarily diagnosed and treated.

Updated guidance from the National Institute for Health and Care Excellence (NICE) will limit the number of people in England and Wales who are diagnosed with chronic kidney disease (CKD).

A NICE spokeswoman said that in the past concerns have been raised that CKD may have been over-diagnosed.

But new information for health workers from NICE, including a set of tables, will help to ensure that there are consistent methods and tests for diagnosing the condition, she said.

“These updated recommendations will… make sure that the right people get the right treatment for their condition”

Mark Baker

People are tested for the condition by assessing the chemical markers in the blood and new guidance from NICE has increased the threshold that determines when a person should receive a diagnosis.

The updated guideline replaces a version published in 2008. Best practice on CKD diagnosis has evolved over the last decade.

In 2004, the Department of Health’s national service framework for renal services adopted the US National Kidney Foundation Kidney Disease Outcomes Quality Initiative classification of CKD.

This classification divides CKD into 5 stages and uses the combination of an index of kidney function, the glomerular filtration rate (GFR), and markers of kidney damage to define the stages.

To delineate an increased risk of adverse outcomes, the 2008 NICE guideline suggested two key changes to this classification: the subdivision of stage 3 into 3a (GFR 45–59 ml/min/1.73 m2) and 3b (30–44 ml/min/1.73 m2), and the addition of the suffix “P” to denote significant proteinuria at any stage.

Then in 2013, Kidney Disease: Improving Global Outcomes guidance on the evaluation and management of chronic kidney disease suggested three albumin:creatinine ratio categories for each GFR category in an updated classification. These have now been added to the NICE guideline.

Professor Mark Baker, director of the Centre for Clinical Practice at NICE, said: “Chronic kidney disease often has no symptoms so can go undetected, potentially leading to serious health problems. Late presentation of people with kidney failure increases sickness and death and costs the NHS more.

“Figures suggest chronic kidney disease costs the NHS in England between £1.44bn and £1.45bn every year,” he said.

“These updated recommendations will enable doctors to make the correct diagnosis of CKD, and make sure that the right people get the right treatment for their condition,” he added.

CKD is a long-term condition where the kidneys do not work effectively. It is more common with age and estimates from the NHS suggest that about one in five men and one in four women between the ages of 65 and 74 has some degree of CKD.

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