Chronic kidney disease
Chronic kidney disease (CKD) is common, frequently unrecognised and can exist with other conditions (for example, cardiovascular disease and diabetes). CKD can progress to end stage renal disease in a small number of people.
CKD is usually asymptomatic but is detectable. Early identification and treatment can prevent or delay progression and the development of complications.
CKD is strongly age–related with nearly a third of people aged over 75 years having CKD stage 3-5.
Why is this issue important?
Chronic kidney disease (CKD) describes reduced or abnormal kidney function and/or structure. It is often unrecognised and can exist with other conditions (for example, cardiovascular disease and diabetes). When advanced, it also carries a higher risk of mortality. Some conditions that coexist with CKD become more severe as kidney dysfunction advances. CKD can progress to established renal failure in a small number of people1.
CKD is usually asymptomatic, but it is detectable, and tests are simple and freely available. There is evidence that early treatment can prevent or delay the progression of CKD, reduce or prevent the development of complications and reduce the risk of cardiovascular disease. However, a lack of specific symptoms means people with CKD are often not diagnosed, or diagnosed late when CKD is at an advanced stage. CKD shares many of the risk factors of other vascular diseases, such as diabetes and high blood pressure1.
The national prevalence of CKD from the 2009 Health Survey of England was 14% in men and 13% in women (all stages, all ages)2. Those suffering CKD stages 3-5 (more advanced disease) were 5% for men and 7% for women. In Kirklees there is a 55% difference between the expected and observed numbers of people living with CKD3. This may indicate issues with detection and/or poor recording.
What significant factors are affecting this issue?
The risk of developing CKD increases with increasing age1. Other factors which increase the risk of CKD include hypertension, diabetes, obesity and smoking4. CKD is more likely to progress to the severe form of end stage renal disease in BME groups4.
A large proportion of people with CKD also have other long-term conditions, in particular cardiovascular disease, and this proportion increases with age5. The risk of death from cardiovascular disease in people with CKD far outweighs the risk of progress of the kidney disese1. Complications of CKD. include6:
- Cardiovascular disease (CVD)
- Mineral and bone disorders (e.g. calcium and phosphate disorders)
- Increased risk of other disease e.g. infection and cancer
- Increased risk of fracture
Having CKD can also increase the risk of hospitalisation, morbidity and death. Reduced kidney function is associated with poorer psychosocial functioning, higher anxiety, higher distress, a decreased sense of well-being, higher depression, and negative health perception7.
The cost of treating end stage renal disease is 1-2% of the NHS budget. Early detection is therefore cost effective for both financial and health outcomes7.
Which groups are most affected by this issue?
CKD is strongly age–related. In 2009 1% of men and 2% of women aged 16-54 years had CKD stage 3-5. In those aged over 75 years 31% of men and 36% of women had CKD stage 3-52. This also showed a slight gender bias towards women.
Locally, the CLIK 2012 survey did not include CKD as a separate disease, but it is likely that of the 1 in 5 adults with hypertension and the 1 in 14 adults with diabetes, 1 in 3 of those aged over 75 years also had CKD8.
Having a family history of kidney disease increases the risk of developing moderate to severe CKD. In women the risk was more than double, and in men, over three times the risk9.
Advanced CKD is more prevalent in south Asians in the UK. Compared with white people they had a 2.3-fold higher risk of advanced CKD12.
What could commissioners and service planners consider?
Strategies aimed at earlier identification and (where possible) prevention of progression to established renal failure are needed. Implementation of the recommendations in NICE Guideline CG73 are therefore vital. This guideline also covered treatment interventions.
Early detection of CKD and good management within primary care are also important to minimise kidney damage. The Renal national service framework advocates quality standards including prevention and early detection of CKD in order to minimise the progression and consequences5 and these need to be implemented and maintained.
GP practices should be actively screening those more likely to have CKD and raising awareness about the disease with patients. Training for primary care staff to ensure that they understand the importance of identifying people with CKD early, and to provide ongoing support in the management of CKD including knowing when to refer to secondary care would also help.
Treatment of the causes and risk factors associated with CKD, such as high blood pressure and diabetes is an important part of the prevention and management of CKD. Cholesterol levels also need to be managed within normal limits. People with CKD are advised to stop smoking, reduce their weight if overweight or obese, eat a healthy diet, take regular exercise and manage other long term conditions like diabetes effectively.
More CKD care should take place closer to home, especially for those patients with established kidney failure who are unsuitable for renal replacement therapy and transplant and those requiring end of life care. Support from secondary care is required to enable CKD patients to be managed safely and effectively in primary care.
- National Institute of Health and Clinical Excellence, 2008. CG 73. Chronic Kidney Disease: Early identification and management of chronic kidney disease in adults in primary and secondary care. http://publications.nice.org.uk/chronic-kidney-disease-cg73 updated Aug 12
- The Information Centre. Health Survey for England 2009 Vol 1, chapter 3. https://catalogue.ic.nhs.uk/publications/public-health/surveys/heal-surv-heal-life-eng-2009/heal-surv-heal-life-eng-2009-rep-v2.pdf
- NHS Kidney Care. Kidney Disease QOF toolkit 2011.
- NHS Kidney Care. Kidney Disease PCT profile. 2010.
- Department of Health. Achieving Excellence in Kidney Care, Delivering the National Service Framework for Kidney Care. 2009.
- Stevens AL et al. Prevalence of CKD and Comorbid Illness in Elderly Patients in the United States: Results From the Kidney Early Evaluation Program (KEEP) Am J Kidney Dis. 2010 Mar;55(3 Suppl 2):S23-33 http://www.kidney.org/news/keep/pdf/adr2009/S23_Stevens_09.pdf
- NHS Kidney Care, 2010. Kidney disease: Key facts and figures Sept 2010
- NHS Kirklees and Kirklees Council. Current Living in Kirklees (CLIK) survey. 2012
- Hippisley-Cox J and Coupland C. Predicting the risk of Chronic Kidney Disease in Men and Women in England and Wales: prospective derivation and external validation of the QKidney® Scores. BMC Family Practice 2010, 11:49
- Roderick et al, 2009. Prevalence of chronic kidney disease in South Asian and Black minorities: findings from a population based screening study in London, UK. Journal of Epidemiol Community Health; 63:64 doi:10.1136/jech.2009.096727l
Date this section was last reviewed