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Table 3 Quality indicators for CKD

From: Developing quality indicators for Chronic Kidney Disease in primary care, extractable from the Electronic Medical Record. A Rand-modified Delphi method

NrDefinition and classification
1aPercentage of patients with a GFR <60 ml/min/1.73 m2 for 3 months, diagnosed with CKD (= diagnosis of CKD present in the problem list of the EMR)
1bPercentage of patients with a GFR < 60 ml/min/1.73 m2, in whom no other measurement was found, who were tested within 3 months
 Screening and diagnosis
2Percentage of patients with hypertension, diabetes mellitus, chronic NSAID use or a history of heart- and blood vessel disease, in whom eGFR and albuminuria is determined once a year
 Management: Follow-up
3Percentage of patients with CKD with a GFR ≥ 60 ml/min/1.73 m2 , whose eGFR is tested annually
4Percentage of patients with CKD with a GFR between 30-59 ml/min/1.73 m2, who are tested every six months
5Percentage of patients with CKD with a GFR between 15-29 ml/min/1.73 m2,who are tested every three months
6Percentage of patients with CKD, in whom the GFR, albuminuria and total protein is determined at least once a year
7aPercentage of patients with CKD with:
- macroalbuminuria or
- microalbuminuria in combination with an eGFR <60 or
- eGFR < 45 ml/min/1.73 m2
in whom serum potassium (on a fresh blood sample), calcium, phosphate, PTH and bicarbonate levels, and Hb is measured at least once a year.
7bPercentage of patients with CKD with macroalbuminuria or microalbuminuria and eGFR <60 or eGFR < 45 ml/min/1.73 m2 and an increased PTH, in whom vitamin D is measured at least once a year.
7cPercentage of patients with CKD with macroalbuminuria or microalbuminuria and eGFR <60 or eGFR < 45 ml/min/1.73 m2 and a reduced Hb, in whom ferritin and transferrin saturation is measured at least once a year.
 Management: Vaccination
8Percentage of patients with CKD who are vaccinated with an influenza vaccine annually
9Percentage of patients with CKD who are vaccinated with a pneumococcal vaccine
10Percentage of patients with CKD with progressive disease (= increasing proteinuria and/or decreasing eGFR) who are vaccinated with a hepatitis B vaccine
 Treatment CKD
11Percentage of patients with CKD , who are encouraged to undertake physical activity compatible with cardiovascular health and tolerance (aiming for at least 30 minutes 5 times per week), to stop smoking and obtain or maintain a healthy weight (BMI 20 to 25; waist circumference ≤ 94 cm in men or ≤ 80 cm in women) and to limit alcohol intake
12Percentage of patients with CKD with a normal albuminuria (<30mg/g or <30 mg/24hours) and an office blood pressure consistently >140 mm Hg systolic or >90 mm Hg diastolic, who are treated with blood pressure-lowering drugs to maintain a blood pressure that is consistently ≤140 mm Hg systolic and ≤90 mm Hg diastolic
13Percentage of patients with CKD with a strongly increased albuminuria (> 300 mg/g or > 300 mg/24 hours) or moderately increased albuminuria (30-300 mg /g or 30-300 mg / 24 hours), who are treated with an ARB or an ACE inhibitor
14Percentage of patients with CKD with an albuminuria ≥300 mg/g creatinine (or ≥300 mg/24 hours or proteinuria ≥0.5 g/24 hours), who are treated by increasing ACE inhibitor or ARB dosage if the maximum dose has not yet been reached.
15Percentage of patients with CKD in whom a one-time lipid profile (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides) is determined
16Percentage of patients with CKD with
- proteinuria ≥1 g/day or
- diabetes mellitus or
- strongly increased albuminuria (ACR >300 mg/g creatinine or >300 mg/24 hours) or
- ACR ≥700 mg/g
in whom the target BP of < 130/80 mmHg (SBP range 120 - 129 mmHg) is achieved by using the first choice antihypertensive drugs (ACE inhibitors or ARBs)
17Percentage of patients with CKD with a reduced serum bicarbonate (<20 mmol / L), who are treated with oral bicarbonate to keep the serum bicarbonate level within the normal range
18Percentage of patients with CKD with a vitamin D deficiency (<15 ng/ml), who are substituted with vitamin D
 Medication and safety of the patient
19Percentage of patients with CKD with a RAAS blocker or spironolactone treatment, in whom potassium level and GFR are measured before initiating this therapy and controlled within 1 week after initiation and after each dose increase
20Percentage of patients with CKD who need an examination with contrast medium and of whom no recent value (last 12 months) of eGFR is known, in whom eGFR is determined
21Percentage of patients with CKD with a GFR < 30 ml/min./1.73m2, in whom metformin is avoided/ is not prescribed
22Percentage of patients with CKD with a GFR < 30 ml/min/1.73 m2, in whom bisphosphonate treatment is avoided/ is not prescribed
23Percentage of patients with CKD with a GFR < 60 ml/min/1.73 m2, in whom oral phosphate-containing bowel preparations are avoided/ are not prescribed
24Percentage of patients with CKD who are referred to a specialist, and for whom the referral letter includes active diagnosis of CKD and renal function
 Referral to a specialist
25Percentage of patients with a GFR <30 ml/min/1,73 m2 , who are referred to a specialist
26Percentage of patients with CKD with hypertension who do not respond to medical treatment with 4 or more antihypertensive drugs, who are referred to a specialist
27Percentage of patients with CKD who are pregnant or are planning pregnancy, who were referred to a specialist
28Percentage of patients with CKD with:
- a chronic eGFR <30 ml/min./1,73 m2
- an eGFR between 30-45 ml/min./1,73 m2 and ACR >200 mg/g for men or 300 mg/g for women , and/or proteinuria >1000 mg/24h or a protein-creatininratio (PCR) > 1 000 mg/g
who are referred to a specialist for inclusion in a care program
29Percentage of patients with a confirmed significant albuminuria (ACR ≥300 mg/g or AER ≥ 300 mg/ 24 hours), who are referred to a specialist
30Percentage of patients with hematuria in combination with proteinuria (urine protein ≥0.5 g/day or PCR ≥500mg/g or ACR ≥ 300 mg/g creatinin), who are referred to a specialist
31Percentage of patients with progression of CKD (confirmed decline in GFR category accompanied by a 25% or greater drop in eGFR from baseline or a sustained decline in eGFR of more than 5 ml/min/1.73 m2 /year), who are referred to a specialist
32Percentage of patients with persistent microscopic hematuria of unknown origin, who are referred to a specialist
33Percentage of patients with persistent serum potassium abnormalities (potassium <4.0 mmol / l or potassium >5.5 mmol / l ), who are referred to a specialist
34Percentage of patients with recurrent or extensive nephrolithiasis, who are referred to a specialist
35Percentage of patients with hereditary kidney disease, who are referred to a specialist
36Percentage of patients with an arteria renalis stenosis, who are referred to a specialist
  1. CKD Chronic Kidney Disease, GFR Glomerular Filtration Rate, PTH Parathyroid hormone, Hb Hemoglobin, ARB Angiotensin II receptor blockers, ACEi angiotensin converting enzyme inhibitor, RAAS renin–angiotensin–aldosterone system, PCR Protein-Creatinine Ratio, ACR albumin to creatinine ratio, AER albumin excretion rate, NSAID non-steroidal anti-inflammatory drug