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Primary care clinicians are key to tackling kidney disease

NHS Kidney Care

Health economics report: Primary care has lead role in early identification of undiagnosed patients and preventing need for costly dialysis or transplant

Posted: 6 August 2012

GPs and primary care nurses are on the frontline in the fight against Chronic Kidney Disease (CKD) says a health economics report published today in the journal Nephrology Dialysis Transplantation.[1]

CKD costs the NHS more than breast, lung, colon and skin cancer combined, yet too many cases remain undiagnosed and untreated, the report says.

There are thought to be around a million people with undiagnosed CKD in England according to the report commissioned by NHS Kidney Care.

Failure to detect CKD patients means they don't get the lifestyle advice and treatment they need.

The study found that half a million people diagnosed with CKD had not been tested by their GP to see if they would benefit from ACEIs (Angiotensin Converting Enzyme Inhibitor) or ARBs (Angiotensin Receptor Blocker) treatments.

Had they been, it estimates a further 29,000 patients may have been prescribed these drugs, reducing the risk of transplant, dialysis, stroke and heart attack and saving the NHS around £13m a year.

The study found that there are 40,000 to 45,000 premature deaths a year in people with CKD.

There are around 7,000 extra strokes and 12,000 extra heart attacks each year among people with CKD (‘extra' means over and above those in people of the same age and gender without CKD).

Chronic kidney disease costs the NHS £1.4 billion a year - more than the spend on breast, lung, colon and skin cancer combined (£1.37billion) according to the in-depth report on the NHS Kidney Care website published simultaneously with the journal article.[2]

Treating kidney disease and its complications takes £1 in every £77 spent by the NHS in England.

NHS Kidney Care, which supports NHS services to improve the care they provide, is urging GPs to find ways to boost detection and early treatment of CKD and has produced a range of tools and support to help health professionals.

Beverley Matthews, Director of NHS Kidney Care, said, "Chronic kidney disease, if unchecked, can have a devastating impact on people's lives and as this study shows, it is also a major drain on NHS resources.

"Better detection and earlier treatment could help tens of thousands of people to lead better lives and free up precious resources to be used elsewhere in the NHS.

"Many GPs and primary care nurses are doing fantastic work to tackle this problem, and we are helping others with education and practical tools to improve care and treatment for people with chronic kidney disease."

Michael Gordon, a GP at the Gleadless Medical Centre in Sheffield and Primary Care Lead for the Yorkshire and the Humber Renal Network, said, "This paper highlights the potential we have in primary care to make a real difference for people with CKD.

"Most experts now accept that CKD is a risk factor for cardiovascular disease and we in primary care need to find ways to overcome the practical challenges involved in achieving timely diagnosis. Earlier identification and treatment is a win-win for patients and the health service.

"I hope this paper acts as a call to action for us all to continue working to find ways to overcome some of the logistical difficulties in obtaining accurate urine protein samples and ensuring we can give the very best care.

"Patients with CKD should be encouraged to ask their doctor - ‘is there protein in my urine? And if there is, do we need to do anything about it?'"

Jan Procter-King is a national primary care cardiovascular nurse based at The Ridge Medical Practice in Bradford and a trainer for NHS Kidney Care; she said, "I spend a lot of time training nurses and GPs across the country about CVD and chronic disease management.

"Kidneys are traditionally included as part of the other cardiovascular disease clinics, hearts and brains can easily take the limelight and the kidneys do not always get the focus they deserve.

"It is essential that we identify and manage CKD for all our patients as the impact of misinformed management as well as possible progression to dialysis is massive for both individuals and the NHS.

"NHS Kidney Care's report demonstrates beyond doubt that we need to give kidneys their due recognition.

"I was involved in the development for some of the training materials offered by NHS Kidney Care and they have proved to be very practical for supporting the frontline."

NHS Kidney Care has produced a range of resources to support healthcare professionals to improve care for people with CKD, including:

  • A resource pack which provides healthcare professionals in primary care with the necessary tools to identify patients with CKD, aid appropriate investigation and treatment and help patients to understand their condition and prepare for the future.
  • A Royal College of General Practitioners online e-learning module on CKD to complement the resource pack and address the education needs of primary care physicians.
  • The Atlas of Variation in Healthcare for People with Kidney Disease - part of Right Care's programme of atlases - to build awareness and stimulate action to address unwarranted variation, enabling providers and commissioners to explore where they may be able to improve the quality of care they provide to kidney patients and identifying areas of good practice so that others can learn from what works well.
  • A CKD Quality and Outcomes Framework (QOF) toolkit which enables practices to see their expected and reported CKD prevalence and benchmark their QOF performance against others.
  • Health Investment Education Packs (HIEPs) which highlight the variation in expenditure, expenditure drivers and the outcomes for kidney disease between primary care trusts and clinical commissioning groups.
     

References

[1] Chronic Kidney Disease in England: The Human and Financial Cost - Marion Kerr, Insight Health Economics for NHS Kidney Care
[2] NHS Programme Budgeting data 2009-10 Chronic Kidney Disease in England: The Human and Financial Cost - Marion Kerr, Insight Health Economics for NHS Kidney Care (The full report is published on the NHS Kidney Care website at http://www.kidneycare.nhs.uk/document.php?o=1284