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March 2020

HCPs overlook important kidney function test



Over half (54%) of GPs and nurses who treat people with type 2 diabetes do not carry out the recommended annual urine albumin-to-creatinine ratio (UACR) test, used to detect kidney damage that can lead to fatal complications, a UK-wide survey suggests.

This is despite both NICE and SIGN recommending that the test should be conducted every year, as it can provide a ‘window of opportunity’ where the rate of kidney damage can be slowed or even halted with the right treatment and lifestyle changes. The most common reason given for the test not being conducted is that many patients are unwilling to provide a simple urine sample.

Around 1.9 million patients with type 2 diabetes in the UK have chronic kidney disease (CKD), which unchecked, can lead to renal failure and the need for renal replacement therapy. There are approximately 800 people with diabetes in the UK waiting for a kidney transplant.

Patients with even minor kidney damage have an increased risk of death compared to those with type 2 diabetes alone, yet because it’s a silent condition, many patients don’t know they have CKD until it’s too late.

By making a small change to clinical practice and by motivating patients to provide urine samples, general practice nurses could have the opportunity to slow kidney damage and reduce the impact of this potentially fatal condition.

Dr Kevin Fernando, a GP with Special Interests in diabetes and medical education, North Berwick Health Centre said: ‘The kidneys are often overlooked in favour of the heart in the treatment of T2D. However, if you protect the kidneys, you can help protect the heart. Any sign of accelerated kidney damage, no matter how early, multiplies the risk of death. By making a small change to clinical practice to routinely measure kidney function and motivate patients to provide samples, doctors and nurses have an opportunity to spot damage early and positively intervene in those patients who are identified as being at risk.’

The survey was conducted in 403 healthcare professionals across the UK and was sponsored by Napp Pharmaceuticals Ltd. The survey was prompted by the results of the annual National Diabetes Audit (2017-18), which found that the UACR test for diabetic kidney disease was the least frequently conducted investigation out of the eight annual care processes NICE recommends for T2D.

  • A separate, large study conducted by researchers from Oxford and Birmingham universities has found that 18% of adults have some degree of CKD, and 13.9% of individuals over the age of 60 years have stage 3-5 CKD. Screening, using measurements of serum creatinine and urinary albumin, suggests that around 8% of all the people are living with undiagnosed chronic kidney disease. Most of them will be unaware that they have the condition, which could be picked up by the NHS Health Check Programme, although only 43% of those invited for these checks attend.

Hirst JA, et al. BJGP. ePub 10 February 2020; bjgp20X708245