Disparities in testing for renal function in UK primary care: cross-sectional study

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Abstract

Background. In the UK, explicit quality standards for chronic disease management, including for diabetes and chronic kidney disease (CKD), are set out National Service Frameworks and pay-for-performance indicators. These conditions are common with a prevalence of 4% and 5.4%, respectively. CKD is largely asymptomatic, detected following renal function testing and important because associated with increased mortality and morbidity, especially in people with diabetes and proteinuria.

Objectives. To investigate who has their renal function tested and any association with age, sex, ethnicity and diabetes.

Method. A cross-sectional survey in a primary care research network in south-west London (n = 220 721). The following data were extracted from routine data: age, gender, ethnicity, latest serum creatinine, diagnosis of diabetes and recording of proteinuria. We used logistic regression to explore any association in testing for CKD.

Results. People (82.1%) with diabetes had renal function and proteinuria tested; the proportion was much smaller (<0.5%) in those without. Women were more likely to have a creatinine test than men (28% versus 24%, P < 0.05), but this association was modified by age, ethnicity and presence of diabetes. People >75 years and with diabetes were most likely to have been tested. Black [adjusted odds ratio (AOR) 2.1, 95% confidence interval (CI) 2.0–2.2] and south Asian (AOR 1.65, 95% CI 1.56–1.75) patients were more likely to be tested than whites. Those where ethnicity was not stated were the only group not tested more than whites.

Conclusions. Quality improvement initiatives and equity audits, which include CKD should take account of disparities in renal function testing.

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