PT  - JOURNAL ARTICLE
AU  - Sarah Tonkin-Crine
AU  - Miriam Santer
AU  - Geraldine M Leydon
AU  - Fliss EM Murtagh
AU  - Ken Farrington
AU  - Fergus Caskey
AU  - Hugh Rayner
AU  - Paul Roderick
TI  - GPs’ views on managing advanced chronic kidney disease in primary care: a qualitative study
AID  - 10.3399/bjgp15X685693
DP  - 2015 Jul 01
TA  - British Journal of General Practice
PG  - e469--e477
VI  - 65
IP  - 636
4099  - http://bjgp.org/content/65/636/e469.short
4100  - http://bjgp.org/content/65/636/e469.full
SO  - Br J Gen Pract2015 Jul 01; 65
AB  - Background Chronic kidney disease (CKD) has become a significant part of the GP’s workload since the introduction of the National Institute for Health and Care Excellence guidelines in 2008. Patients with advanced CKD (stages G4 and G5) often have comorbidities, varied disease progression, and are likely to be older. GPs may experience difficulties with management decisions for patients with advanced CKD, including when to refer to nephrology.Aim To explore GPs’ views of managing patients with advanced CKD and referral to secondary care.Design and setting Qualitative study with GPs in four areas of England: London, Bristol, Birmingham, and Stevenage.Method Semi-structured interviews with 19 GPs. Transcribed interviews were thematically analysed.Results GPs had little experience of managing patients with advanced CKD, including those on dialysis or having conservative care (treatment without dialysis or a transplant), and welcomed guidance. Some GPs referred patients based on renal function alone and some used wider criteria including age and multimorbidity. GPs reported a tension between national guidance and local advice, and some had learnt from experience that patients were discharged back to primary care. GPs with more experience of managing CKD referred patients later, or sometimes not at all, if there were no additional problems and if dialysis was seen as not in the patient’s interests.Conclusion GPs want guidance on managing older patients with advanced CKD and comorbidities, which better incorporates agreement between local and national recommendations to clarify referral criteria. GPs are not generally aware of conservative care programmes provided by renal units, however, they appear happy to contribute to such care or alternatively, lead conservative management with input from renal teams.