TY - JOUR AU - Cleary, F. AU - Kim, L. AU - Prieto-Merino, D. AU - Wheeler, D. AU - Steenkamp, R. AU - Fluck, R. AU - Adlam, D. AU - Denaxas, S. AU - Griffith, K. AU - Loud, F. AU - Hull, S. AU - Caplin, B. AU - Nitsch, D. KW - Chronic renal failure KW - EPIDEMIOLOGY KW - PRIMARY CARE KW - PUBLIC HEALTH KW - Quality in health care T1 - Association between practice coding of chronic kidney disease (CKD) in primary care and subsequent hospitalisations and death: a cohort analysis using national audit data LA - eng PY - 2022/10/11/ T2 - BMJ Open SN - 2044-6055 VL - 12 IS - 10 PB - BMJ Publishing Group AB - Objective To examine the association between practice percentage coding of chronic kidney disease (CKD) in primary care with risk of subsequent hospitalisations and death. Design Retrospective cohort study using linked electronic healthcare records. Setting 637 general practitioner (GP) practices in England. Participants 167 208 patients with CKD stages 3-5 identified by 2 measures of estimated glomerular filtration rate <60 mL/min/1.73 m 2, separated by at least 90 days, excluding those with coded initiation of renal replacement therapy. Main outcome measures Hospitalisations with cardiovascular (CV) events, heart failure (HF), acute kidney injury (AKI) and all-cause mortality Results Participants were followed for (median) 3.8 years for hospital outcomes and 4.3 years for deaths. Rates of hospitalisations with CV events and HF were lower in practices with higher percentage CKD coding. Trends of a small reduction in AKI but no substantial change in rate of deaths were also observed as CKD coding increased. Compared with patients in the median performing practice (74% coded), patients in practices coding 55% of CKD cases had a higher rate of CV hospitalisations (HR 1.061 (95% CI 1.015 to 1.109)) and HF hospitalisations (HR 1.097 (95% CI 1.013 to 1.187)) and patients in practices coding 88% of CKD cases had a reduced rate of CV hospitalisations (HR 0.957 (95% CI 0.920 to 0.996)) and HF hospitalisations (HR 0.918 (95% CI 0.855 to 0.985)). We estimate that 9.0% of CV hospitalisations and 16.0% of HF hospitalisations could be prevented by improving practice CKD coding from 55% to 88%. Prescription of antihypertensives was the most dominant predictor of a reduction in hospitalisation rates for patients with CKD, followed by albuminuria testing and use of statins. Conclusions Higher levels of CKD coding by GP practices were associated with lower rates of CV and HF events, which may be driven by increased use of antihypertensives and regular albuminuria testing, although residual confounding cannot be ruled out. DO - 10.1136/BMJOPEN-2022-064513 UR - https://portalcientifico.uah.es/documentos/642b389ea1c8a315fd235b87 DP - Dialnet - Portal de la Investigación ER -