Evidence map›Paper›PMID 31196901›Full record

Observational studyBMJ open2019

Trends in kidney function testing in UK primary care since the introduction of the quality and outcomes framework: a retrospective cohort study using CPRD.

Benjamin Feakins, Jason Oke, Emily McFadden, Jeffrey Aronson, Daniel Lasserson, Christopher O'Callaghan, Clare Taylor, Nathan Hill, Richard Stevens, Rafael Perera

Erratum issuedOpen access · goldAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
1.2field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 16 citations in OpenAlex.

  1. Article
  2. Article
  3. Article
  4. Article
  5. Article
  6. Article
  7. Article
  8. Preventing CKD in Developed Countries.Kidney international reports · 2020
    Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 1 country.

Benjamin FeakinsNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK.ORCID 0000-0002-3928-6750
Jason OkeNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK.
Emily McFaddenNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK.
Jeffrey AronsonNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK.
Daniel LassersonInstitute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK.ORCID 0000-0001-8274-5580
Christopher O'CallaghanNuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK.
Clare TaylorNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK.ORCID 0000-0001-8926-2581
Nathan HillBristol-Myers Squibb Pharmaceuticals Ltd, Uxbridge, Hillingdon, UK.
Richard StevensNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK.
Rafael PereraNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK.
University of Oxford · GBHillingdon Hospital · GBJohn Radcliffe Hospital · GB

Funding

Department of Health RP-PG-1210-12003
6 · The paper itself

Abstract

objectivesTo characterise serum creatinine and urinary protein testing in UK general practices from 2005 to 2013 and to examine how the frequency of testing varies across demographic factors, with the presence of chronic conditions and with the prescribing of drugs for which kidney function monitoring is recommended.

designRetrospective open cohort study.

settingRoutinely collected data from 630 UK general practices contributing to the Clinical Practice Research Datalink.

participants4 573 275 patients aged over 18 years registered at up-to-standard practices between 1 April 2005 and 31 March 2013. At study entry, no patients were kidney transplant donors or recipients, pregnant or on dialysis. PRIMARY OUTCOME MEASURES: The rate of serum creatinine and urinary protein testing per year and the percentage of patients with isolated and repeated testing per year.

resultsThe rate of serum creatinine testing increased linearly across all age groups. The rate of proteinuria testing increased sharply in the 2009-2010 financial year but only for patients aged 60 years or over. For patients with established chronic kidney disease (CKD), creatinine testing increased rapidly in 2006-2007 and 2007-2008, and proteinuria testing in 2009-2010, reflecting the introduction of Quality and Outcomes Framework indicators. In adjusted analyses, CKD Read codes were associated with up to a twofold increase in the rate of serum creatinine testing, while other chronic conditions and potentially nephrotoxic drugs were associated with up to a sixfold increase. Regional variation in serum creatinine testing reflected country boundaries.

conclusionsOver a nine-year period, there have been increases in the numbers of patients having kidney function tests annually and in the frequency of testing. Changes in the recommended management of CKD in primary care were the primary determinant, and increases persist even after controlling for demographic and patient-level factors. Future studies should address whether increased testing has led to better outcomes.

Indexed as

AdolescentAdultAgedAged, 80 and overBiomarkersCreatinineFacilities and Services UtilizationFemaleGeneral PracticeHumansKidney Function TestsMaleMiddle AgedOutcome Assessment, Health CareProteinuriaQuality Assurance, Health CareBiomarkersCreatininechronic kidney diseasekidney functionmonitoringprimary careproteinuriaserum creatinine

Identifiers

PMID31196901
PMCPMC6575820
OpenAlexW2947252872

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.