A programme to spread glomerular filtration rate (eGFR) graph surveillance for the early identification, support and treatment of people with progressive chronic kidney disease

Plain English summary of protocol

Background and study aims
Chronic kidney disease (CKD) is a long-term condition where the kidneys do not work properly. In a healthy person, the kidneys are vital for filtering out the waste products and excess water in the blood, and converting them into urine. In patients suffering from CKD, the kidneys are unable to do this, and so the body is unable to get rid of the waste products building up in the blood. CKD is common, affecting over 10% of the adult population. It is frequently unrecognised since it causes no symptoms in the early stages. CKD often exists together with other conditions, particularly high blood pressure and diabetes. Some people with CKD develop kidney disease that worsens over time (progressive disease). In the most advanced stages, treatment using machines to do the work of the kidneys (dialysis) or transplants are the only way to keep people alive. People with progressive disease who are referred late by their GPs to kidney units treatment have a lower risk of surviving. Late referral is therefore a major, and preventable, cause of harm in these people. Early identification of people with progressive disease would also create opportunities to start treatment to slow disease progression. The aim of this project is to improve the treatment and outcomes of CKD patients at high risk of kidney failure and other complications.

Who can participate?
Patients with chronic kidney disease.

What does the study involve?
Information on each of the participants on pathology computer systems are used to generate a graph of kidney function over time. In cases where the graph shows that kidney function is getting worse, these are highlighted for review by a laboratory scientist. For participants that are identified as being of “high-risk” a paper copy of the graph is sent to the general practitioner with a prompt that further action may be needed. In this way the project takes information already available and highlights trends over time to primary care. The intervention is to be rolled-out sequentially, with renal centres (and their associated pathology laboratories) starting eGFR graph reporting at staggered time points. Four or five renal centres begin the intervention at each step with a six-month interval between steps.
(Removed 20/05/2019: The start time of the program is chosen randomly.)

What are the possible benefits and risks of participating?
Individual patients do not have any additional testing and there are no significant burdens or risks.

Where is the study run from?
22 NHS sites in the UK

When is the study starting and how long is it expected to run for?
September 2014 to December 2017

Who is funding the study?
Health Foundation (UK)

Who is the main contact?
1. Dr Hugh Gallagher (scientific)
2. Ms Rowena Sampson (public)
Assist@kidneyresearchuk.org

Contact information

Study information

Eligibility

Locations

Countries of recruitment

• United Kingdom
• England
• Northern Ireland
• Scotland
• Wales

Study participating centres

Results and Publications

Study outputs

Editorial Notes

07/01/2022: Publication references added.
20/05/2019: The following changes were made to the trial record:
1. The study design was changed.
2. The secondary study design was changed from Stepped wedge randomised to Quasi-experimental study.
3. The interventions were changed.
4. The plain English summary was updated to reflect these changes.
04/04/2017: Internal review.