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Audit-based education lowers systolic blood pressure in chronic kidney disease: the Quality Improvement in CKD (QICKD) trial results.

de Lusignan, S, Gallagher, H, Jones, S, Chan, T, van Vlymen, J, Tahir, A, Thomas, N, Jain, N, Dmitrieva, O, Rafi, I, McGovern, A and Harris, K (2013) Audit-based education lowers systolic blood pressure in chronic kidney disease: the Quality Improvement in CKD (QICKD) trial results. Kidney International.

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Abstract

Strict control of systolic blood pressure is known to slow progression of chronic kidney disease (CKD). Here we compared audit-based education (ABE) to guidelines and prompts or usual practice in lowering systolic blood pressure in people with CKD. This 2-year cluster randomized trial included 93 volunteer general practices randomized into three arms with 30 ABE practices, 32 with guidelines and prompts, and 31 usual practices. An intervention effect on the primary outcome, systolic blood pressure, was calculated using a multilevel model to predict changes after the intervention. The prevalence of CKD was 7.29% (41,183 of 565,016 patients) with all cardiovascular comorbidities more common in those with CKD. Our models showed that the systolic blood pressure was significantly lowered by 2.41 mm Hg (CI 0.59–4.29 mm Hg), in the ABE practices with an odds ratio of achieving at least a 5 mm Hg reduction in systolic blood pressure of 1.24 (CI 1.05–1.45). Practices exposed to guidelines and prompts produced no significant change compared to usual practice. Male gender, ABE, ischemic heart disease, and congestive heart failure were independently associated with a greater lowering of systolic blood pressure but the converse applied to hypertension and age over 75 years. There were no reports of harm. Thus, individuals receiving ABE are more likely to achieve a lower blood pressure than those receiving only usual practice. The findings should be interpreted with caution due to the wide confidence intervals.

Item Type: Article
Divisions : Faculty of Arts and Social Sciences > Surrey Business School
Authors :
AuthorsEmailORCID
de Lusignan, SUNSPECIFIEDUNSPECIFIED
Gallagher, HUNSPECIFIEDUNSPECIFIED
Jones, SUNSPECIFIEDUNSPECIFIED
Chan, TUNSPECIFIEDUNSPECIFIED
van Vlymen, JUNSPECIFIEDUNSPECIFIED
Tahir, AUNSPECIFIEDUNSPECIFIED
Thomas, NUNSPECIFIEDUNSPECIFIED
Jain, NUNSPECIFIEDUNSPECIFIED
Dmitrieva, OUNSPECIFIEDUNSPECIFIED
Rafi, IUNSPECIFIEDUNSPECIFIED
McGovern, AUNSPECIFIEDUNSPECIFIED
Harris, KUNSPECIFIEDUNSPECIFIED
Date : 27 March 2013
Identification Number : 10.1038/ki.2013.96
Additional Information : Copyright 2013 International Society of Nephrology
Depositing User : Symplectic Elements
Date Deposited : 19 Apr 2013 09:18
Last Modified : 26 Jul 2016 10:09
URI: http://epubs.surrey.ac.uk/id/eprint/768488

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