Kidney conditions: CKD and blood pressure when ACR 70 or more

  • NICE indicator
  • IND264
  • Published:
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Indicator

The percentage of patients on the CKD register and with an albumin to creatinine ratio (ACR) of 70 mg/mmol or more, without moderate or severe frailty, in whom the last blood pressure reading (measured in the preceding 12 months) is less than 125/75 mmHg if using ambulatory or home monitoring, or less than 130/80 mmHg if monitored in clinic.

Indicator type

General practice indicator for use outside the Quality and Outcomes Framework (QOF). Assessment of available data during development and testing showed less than 5 patients eligible for inclusion in the denominator, per average practice with 10,000 patients, prior to application of personalised care adjustments.

This document does not represent formal NICE guidance. For a full list of NICE indicators, see our menu of indicators.

To find out how to use indicators and how we develop them, see our NICE indicator process guide.

Rationale

Chronic kidney disease (CKD) is a long-term condition characterised by abnormal function or structure (or both). Optimal blood pressure control can slow progression of CKD and reduce the risk of cardiovascular disease. A focus on people without moderate or severe frailty allows for an individualised management approach that adjusts care according to frailty status. The General Medical Service (GMS) contract requires practices to use an appropriate tool (such as the electronic frailty index) to identity moderate and severe frailty in patients 65 years and over. It also requires secondary validation.

Source guidance

Chronic kidney disease: assessment and management. NICE guideline NG203 (2021), recommendation 1.6.2

Hypertension in adults: diagnosis and management. NICE guideline NG136 (2019, updated 2023), recommendations 1.4.10, 1.4.18, 1.4.20 and 1.4.22

Specification

Numerator: The number of patients in the denominator in whom the last blood pressure reading (measured in the preceding 12 months) is less than 125/75 mmHg if using ambulatory or home monitoring, or less than 130/80 mmHg if monitored in clinic.

Denominator: The number of patients on the CKD register and with an ACR of 70 mg/mmol or more, without moderate or severe frailty.

Calculation: Numerator divided by the denominator, multiplied by 100.

Definitions:

  • The CKD register includes patients aged 18 and over with CKD stages G3a to G5.

  • The last recorded reading of ACR should be used for inclusion in the denominator.

Exclusions: None.

Personalised care adjustments or exception reporting should be considered to account for situations where the patient declines, does not attend or if the blood pressure target is not appropriate.

Expected population size: CPRD Aurum data (March 2022 release; on file, approved study protocol 23_002668) shows that less than 0.1% of people in England are on the CKD register and with an albumin to creatinine ratio (ACR) of 70 mg/mmol or more, without moderate or severe frailty: less than 5 patients for an average practice with 10,000 patients. There is no minimum number of patients required for general practice indicators intended for use outside the QOF. However, consideration should be given to whether the majority of results would require suppression because of small numbers.

Note on data from CPRD Aurum: This study is based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The data is provided by patients and collected by the NHS as part of their care and support. The interpretation and conclusions contained in this study are those of the authors alone.

ISBN: 978-1-4731-5799-6