Nicola
Thomas
Research Lead Nurse, St. Helier
Hospital
Part Two of the National Service
Framework (NSF) for Renal Services1 calls for prevention and early
detection of chronic kidney disease (CKD) alongside minimisation of the
progression of the disease and its consequences. Many renal units are starting
to collaborate with primary care teams in achieving these objectives, and this
presentation will outline a pilot study with six GP surgeries in SW London that
has been carried out as part of a four-year research project.
The study
is following a cohort of 380 patients who have diabetic kidney disease, stages
1–4.2 At the start of the study all had microalbuminuria (MA) with
normal/abnormal serum creatinine, but had not been referred to the nephrology
service. Data on prevalence of diabetic nephropathy and numbers of patients who
needed renal intervention will be shown.
The
presentation will demonstrate how quality requirements one and two of the NSF
can start to be achieved in the areas of identification of ‘at risk’ patients,
and management of early diabetic nephropathy. The practicalities of audit
(numbers of patients), development of referral guidelines and education and
support of primary care professionals will be discussed.
The presentation will detail the
effectiveness of working with GPs and practice nurses, and will give examples
of success with existing patients. There will be evaluation of a ‘best-practice
model’ in setting up a CKD programme in the community, and the possible
benefits for all involved – patients, primary care and renal professionals.
Finally a vision for the future management of patients in the community with
CKD will be shown.
References
1.
National Service Framework for Renal Services – Part Two: Chronic kidney
disease, acute renal failure and end of life care, DoH, 2005.
2. Thomas,
N. Br J Diab Vasc Dis 2004; 4 (3): 202–204.