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This important 3 year project focuses on the identification and management of people with CKD (Chronic Kidney Disease) in primary care to: Improve the identification of CKD patients in primary care, improve the management and outcomes of CKD patients and tailor the care of people with CKD to local care pathways.

National CKD Audit

The National Chronic Kidney Disease Audit (NCKDA) focuses on the identification and management of people with CKD (Chronic Kidney Disease) in primary care.

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The Audit
The Audit CKD Audit

The National CKD Audit was implemented in England and Wales in 2015-2016 to review variation in patient care with regards to the identification and management of patients with chronic kidney disease in primary care. The Audit team developed quality improvement tools which were embedded in the Informatica software, allowing improved patient identification and more targeted management of those at risk. The collection of primary care data was discontinued in 2016.

The National CKD Audit Data on are now used for further research on which aspects of primary care management improve long-term patient outcomes of patients at risk of or with kidney disease.

Pseudoanonymised data from the Audit are held for analysis at the London School of Hygiene & Tropical medicine. Pseudoanoymisation means that there are no individual identifiers that allow linking the health information back to individuals. The information on NHS numbers and corresponding pseudo-identifiers are held separately at UCL in a super-secure server.

The National CKD Audit Data will be linked to information held at the UK Renal Registry and to data on heart disease held at the National Institute for Cardiovascular Outcomes Research. This will allow tracking the long-term outcomes of patients over the next 5 years. The data linkage will be done by trusted third parties to maintain maximum confidentiality of the patient data.

If you are considering requesting that your data not be used for this audit it is recommended that you discuss this with your local GP. If you then decide that you wish to 'opt-out' of the audit you will need to ask your GP to mark your local record as opted out. Then no further data will be shared with us, or any other national audit.

What regions does it cover?

The current coverage is shown below

Click on a CCG or LHB for more details.

Data collection

How do we collect data?

Data was collected using Informatica's National CKD Audit software which is provided free of charge to participating practices. The software was delivered by a short remote installation process. The National CKD Audit solution automatically integrated with the GP clinical system to collect primary care data. Each GP Practice was identified as an individual entity, giving greater visibility of CKD care at a practice or at a local level.

The audit process ran each night and compiled a full audit for each GP practice. This information can be accessed and used within the practice and it was transmitted back to a secure central data warehouse on the NHS N3 network on two occasions.

What information is collected?

From the GP Primary Care clinical system, the National CKD Audit has collected a patient’s:

  • age, sex, ethnicity, post-code (to calculate Index of Multiple Deprivation [IMD])
  • risk factors and relevant comorbidities for CKD in those who should be tested (cardiovascular disease, smoking, hypertension, diabetes mellitus, atrial fibrillation, obesity, gout, underlying kidney disease, osteoporosis, anaemia, cancer, systemic disease, dementia, mental health problems)
  • medications (anti-hypertensive drugs in different drug classes, statins, nephrotoxic drugs, aspirin, warfarin, diabetes medication) with prescription dates from GP records
  • laboratory tests and results
  • listing on existing registers like diabetes mellitus, hypertension, cardiovascular disease and atrial fibrillation.

We also collected a wide range of social indicators which are used to audit the equity of care. Most data will be routinely available data (HES/PEDW, ONS, NDA) and/or extracted from GP practice clinical systems.

To find out more about the type of data that is collected, please download the Information sheet. For further information on the basis by which audit measures have been calculated please see the Categorisation Method and Variables List.

The full list of READ codes is found here.

Datasets are then linked to Secondary Care (HES/PEDW), Office of National Statistics data, the UK renal Registry and NICOR (for cardiovascular outcomes). To do this, we use the patient identifiable data (NHS number).

Once this linkage is complete, we anonymise the data by blocking the identifiable elements, before supplying it to LSHTM where the anonymised research database is held.

How is privacy protected?

The programme has obtained Section 60 /Section 251 Health and Social Care Act / NHS Act approval from the Confidentiality Advisory Group of the Health Research Authority, which is particularly interested in the data linkages with other databases.

Once that linkage is achieved, data which can be used to identify patients, such as patient NHS numbers, is blocked (using an SHA256 hash function algorithm). The resulting pseudoanonymised data set held at LSHTM for further analysis.

If you are considering requesting that your data not be used for this audit it is recommended that you discuss this with your local GP. Please also check the information on opt out on the National Opt Out Programme website. If you then decide that you wish to 'opt-out' of the audit you will need to ask your GP to mark your local record as opted out. Then no further data will be shared with us, or any other national audit.

Can others access the data?

The National CKD Audit was commissioned by HQIP on behalf of NHS England's National Clinical Audit and Patient Outcome Programme (NCAPOP). It is recognised that the data collected under NCAPOP is a valuable resource that should be made available to appropriate related healthcare organisations.

Requests for data access must be made using the HQIP data access request process available on their website, and advice on how to do this can be obtained from the Steering committee of the database.

Depending on the types of data required, further data sharing requests and approvals need to be obtained from the UK Renal Registry and NICOR.

History
History CKD Audit

The National Chronic Kidney Disease Audit was commissioned by the Healthcare Quality Improvement Partnership (HQIP), and funded by NHS England; as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP); and the Welsh Government.

This important 3 year project focused on the identification and management of people with CKD (Chronic Kidney Disease) in primary care to:

  • Improve the identification of CKD patients in primary care
  • Improve the management and outcomes of CKD patients
  • Tailor the care of people with CKD to local care pathways.

The National CKD Audit collected and analysed data and produced reports for practices, CCGs/LHBs, as well as a publicly available national reports. It also provided Quality Improvement Tools which GPs may wish to use to help manage people with CKD.

The Audit was delivered by Informatica (initially part of the BMJ) working with UCL Centre for NephrologyLSHTM, Clinical Effectiveness Group QMUL, with input from the Patient Liaison Group. Clinicians and people with CKD were actively encouraged to participate in the audit to drive changes and improve the quality of services and health outcomes for people with CKD in England and Wales.

"From my point of view, as a kidney doctor for over 25 years, one of the most enduring themes has been encountering missed opportunities to identify kidney disease early, therefore not being able to prevent its complications or enable the planning of future care in partnership with patients."

Dr Donal O’Donoghue FRCP
National Clinical Director for Kidney Care
May 2012

Glossary
Glossary CKD Audit
Term Description
Audit

An audit is a planned and documented activity performed by qualified personnel to determine by investigation, examination, or evaluation of objective evidence, the adequacy and compliance with established procedures, or applicable documents, and the effectiveness of implementation.

The National CKD Audit aims to investigate the prevalence of CKD and identify whether the management of CKD can be improved through better early stage diagnosis.

Chronic Kidney Disease (CKD)

CKD means that your kidneys are diseased or damaged in some way, or are ageing. As a result, your kidneys may not work as well as they used to. So, the various functions of the kidney can be affected. A whole range of conditions can cause CKD.

Chronic means ongoing (persistent or long-term). It does not mean severe as some people think. You can have a mild chronic disease. Many people have mild CKD.

CKD can sometimes be described as chronic renal failure.

Further information can be found here.

Pseudoanonymisation

Pseudoanonymisation is described by the NHS as:

“the technical process of replacing person identifiers in a dataset with other values (pseudonyms) available to the data user, from which the identities of individuals cannot be intrinsically inferred, for example replacing an NHS number with another random number, replacing a name with a code or replacing an address with a location code. Pseudonyms themselves should not contain any information that could identify the individual to which they relate (e.g. should not be made up of characters from the date of birth, etc.).”

Steering committee
Steering committee CKD Audit
David Wheeler (UCL Nephrology) Chair
Spiros Denaxas UCL Farr
Dr David Adlam NICOR
Dr Chris Gale NICOR representative, Leeds
Dr Fergus Caskey UK Renal Registry
Dr Stephanie McNeill UK Renal Registry
Dr Richard Fluck National Think Kidneys Programme
Dr Dorothea Nitsch LSHTM
Dr Ben Caplin UCL Nephrology
Welsh representative To be nominated
Dr Kathryn Griffith RCGP
Dr Sally Hull GP
Contact
Contact CKD Audit

Please email dorothea.nitsch@lshtm.ac.uk for initial queries.