Kidney Research UK

Chronic Kidney Disease Prevalence

Background

Founded in 1961, Kidney Research UK (formerly the National Kidney Research Fund) is the largest funder of research into the prevention, treatment and management of kidney disease. Our mission is to improve the quality of life of those with kidney disorders and to increase public awareness of kidney health.

We recognise the importance of early detection and prevention in tackling the onset of kidney disease, particularly among “at risk” groups such as those with diabetes and cardiovascular disease, or from ethnic minorities. By diagnosing and treating kidney disease at an early stage, the likelihood of established renal failure is reduced, and therefore the need for transplantation or lifelong dialysis treatment.

Chronic Kidney Disease (CKD)

This term describes any irreversible damage to the kidney. This may be associated with a significant loss of kidney function (kidney failure) in a minority of people. In some it may be progressive resulting in ill health.

Damage can be caused common disease such as diabetes mellitus, or more rarely by diseases specifically affecting the kidneys directly.

In the early stages CKD causes no symptoms. Only in a minority of patients does it progress to end stage or established kidney failure which means that either dialysis or renal transplantation (renal replacement therapy or RRT) are required to keep the patient alive. However, it is a strong risk factor for heart problems, and highlights the need for careful attention to the heart.

Prevalence of Chronic Kidney Disease

About 100 per million of the UK population reach end-stage renal failure each year and 600-800 per million reply on dialysis or transplant for survival. The number of patients is increasing by ~5% per annum. A similar number ~ 1000 per million (0.1%) have severe kidney damage and may need renal replacement. A much larger number have mild kidney damage but the majority of these will never progress to the point where they need treatment for kidney failure.

Stages of Chronic Kidney Disease

Both the UK and many other countries have adopted a US classification of CKD that describes 5 stages. The staging is based around a simple measure of kidney function (discussed below), and allows the structured care of patients with CKD. It is important to understand that patients do not inevitably move towards stage 5. Most patients will remain very stable.

Stage 1 is the presence of kidney damage without an effect on function

Stage 2 is the presence of kidney damage with slight effect on function

Stage 3 is the presence of reduced function

Stage 4 is severely reduced function with complications

Stage 5 is life threatening reduction in function

Consequences of undetected Chronic Kidney Disease

If progressive CKD is undetected patients have no opportunity to the progression of kidney disease slowed, to have the complications of kidney disease treated, or to have the kidney disease itself treated where specific therapies exist. They may reach end stage kidney failure poorly prepared, increasing the risk of complications and death Currently, in the United Kingdom, it is estimated that 30% of patients need to start dialysis within three months of first being seen by a kidney specialist. These patients will start dialysis unprepared and with complications such as anaemia and bone disease undertreated.

Detecting Chronic Kidney Disease

The state of the kidneys can be easily assessed by a blood test for creatinine which can be converted into an estimate of function (eGFR or estimated glomerular filtration rate) and testing the urine for excess protein. Using these simple tests in conjunction with the staging system allows GPs and specialists to provide structured care for individuals. For many people this will be about monitoring the kidney condition to watch for a decline, lifestyle advice (especially about smoking) and good blood pressure control. For those with advanced problems, with complications or with evidence of progressive kidney damage this may require the advice of kidney specialists.

By increasing awareness of kidney disease for both individuals and health care professionals, there will be improved monitoring, treatment and preparation of people with CKD.

It is so important that the first signs of potential Chronic Kidney Disease are found early, when diagnosis and treatment are easier and it is possible to slow down or even stop the progression of kidney disease. Research is vital to underpin this early identification and prevalence of CKD.