TY - JOUR T1 - Chronic kidney disease: a new priority for primary care JF - British Journal of General Practice JO - Br J Gen Pract SP - 908 LP - 910 VL - 56 IS - 533 AU - Gabriela B Gomez AU - Simon de Lusignan AU - Hugh Gallagher Y1 - 2006/12/01 UR - http://bjgp.org/content/56/533/908.abstract N2 - Chronic kidney disease is a long-term condition that has been the focus of important recent initiatives. Although only a small minority of individuals with this condition will develop end-stage renal disease, the presence of even minor renal impairment is an independent risk factor for all cause mortality and cardiovascular disease.1 The number of patients treated with end-stage renal failure is increasing dramatically in the UK. Projections for hospital-based haemodialysis indicate an annual growth rate of 6–8%; a steady state is not predicted for at least 20 years.2 Currently one-third of people reach specialist renal services less than a month before requiring renal replacement, and this group has poorer outcomes.3 Measuring renal function in primary care has the potential to prevent these late referrals by slowing the progression of chronic kidney disease.There are many causes of chronic kidney disease (Box 1). Their relative importance depends upon age with, for example, acquired obstructive and reflux nephropathies affecting older and younger age groups, respectively. The causes cover a range of severity; patients with adult polycystic kidney disease or established diabetic nephropathy are, for example, more likely to progress to dialysis dependence than those with hypertension or non-diabetic vascular disease. The prevalence of both diabetes mellitus and hypertension are increasing in the developed world. Diabetes is the commonest cause of end-stage renal failure worldwide.Box 1. Causes of chronic kidney disease▸ Diabetes mellitus▸ Hypertension and vascular disease▸ Acquired obstructive uropathy — especially prostate disease▸ Glomerular disease — for example glomerulonephritis▸ Adult polycystic kidney disease▸ Reflux nephropathyEstimated glomerular filtration rate (eGFR) is a better measure of renal function than serum creatinine. The latter … ER -