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The June editorial1 makes it clear what the authors feel the responsibilities of primary care are in the management of CKD.
May I be allowed to list the responsibilities of secondary care and policy makers?
Can we be sure that screening for CKD and then treating patients as high risk of CHD will really make a difference? What I need to know are some real figures, such as the number needed to treat. At every meeting I have attended no nephrologist has been able to tell me how many patients I will need to treat for their CKD stage III to save a life. I know they are at greater risk of dying. It is whether we can do anything to change that. Not one nephrologist has had the answer. Perhaps you do?
I now have some experience of managing CKD and it seems to me that there are two main groups:
I was at the Kings Fund recently when the QOF targets for blood pressure management in CKD came up. A professor from Birmingham, I think, said how surprised she was that this target was not being hit. Yet the target is very tough, and most hypertension studies (ASCOT for example) show even in the environment of a study a minority of patients hit this level of target.
GPs' primary role is to be the patient advocate, and to ensure we do the best for them. Many of us are not yet convinced that good data supports NICE guidance that was based largely on consensus among nephrologists with little experience of primary care.
I am not suggesting that GPs don't bother. I am suggesting that good medicine required thought, evidence, and discussion. We are partners as you say.