Impact of ethnicity on the development of kidney disease in the UK, a retrospective database study

Date of ISAC Approval: 
09/07/2018
Lay Summary: 
Long term kidney weakness affects up to 10% of adults in the UK. It is recognised kidney disease may affect people from different ethnic groups differently. In the UK patients from ethnic minorities make up a disproportionately large portion of patients receiving treatment for kidney failure but it's unclear why. Current guidelines on kidney disease take into account ethnicity in only a limited way, a more accurate way to measure kidney disease in patients with South Asian ethnicity has been proposed but not currently used. Using data from the CPRD data, this study aims to understand how using a more ethnic group specific calculation for kidney disease in South Asians could better predict the rate at which kidney failure develops, as well as heart disease which is linked to kidney disease, and deaths over a 10 year period. We will also compare the rate of kidney failure, and deaths over a 10 year period for South Asian patients compared to other ethnic groups. This project will highlight any systematic underdiagnoses of kidney disease in ethnic groups, differences in management, and any identify any need to change clinical practice in order to better improve outcomes.
Technical Summary: 
Chronic kidney disease (CKD) affects up to 10% of the adult population, patients are identified using the Chronic Kidney Disease Epidemiology Collaboration CKD (CKD EPI) equation. UK registry data shows the incidence of dialysis in South Asian patients is much higher than other ethnic groups, the reason for this is not clear. The current method for detecting CKD may be improved upon using more ethnic group specific estimated glomerular filtration rate (eGFR) calculations which is currently not carried out in clinical practice. We will carry out an observational, retrospective cohort database study using CPRD data. We will extract data for South Asian patients from the CPRD and compare the performance of an ethnic group specific eGFR formula in determining rate of decline in kidney function, development of cardiovascular complications, and mortality over a 10 year period versus the current non ethnic group specific eGFR formulae. We will also assess the risk factors associated with of CKD progression in South Asian groups compared to other ethnic groups in the UK, by using a random comparison group from the CPRD dataset.
Health Outcomes to be Measured: 
- Change in prevalence of CKD in South Asian groups when eGFR is reclassified using ethnic group specific eGFR formula compared to standard CKD EPI formula. - Difference in progression of CKD in South Asian groups as reclassified by ethnic group specific eGFR calculations. - Difference in mortality and Renal failure trends in South Asian groups using reclassified eGFR. - risk factors associated with of CKD progression in South Asian groups compared to other ethnic group.
Collaborators: 

Dr Gang Xu - Chief Investigator - University Hospitals Of Leicester
David Shepherd - Collaborator - Leicester City CCG
Dr Francesco Zaccardi - Collaborator - University Of Leicester
Dr Gang Xu - Corresponding Applicant - University Hospitals Of Leicester
Hajra Okhai - Collaborator - University Of Leicester
Professor Kamlesh Khunti - Collaborator - University Of Leicester
Nigel Brunskill - Collaborator - University Hospitals Of Leicester
Dr Rupert Major - Collaborator - University Hospitals Of Leicester
Dr Shafi Malik - Collaborator - University Hospitals Of Leicester

Linkages: 
HES Admitted;ONS;Practice IMD (Non-standard)