Kidney Research UK

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 support the need for 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

Chronic Kidney Disease (CKD) is a long-term condition, which is sometimes progressive and irreversible.

In these very early stages, it can be almost undetectable; however, in a significant minority of people it will progress into established renal failure (ERF), treatment for which is either life-long dialysis or a transplant. Early identification and diagnosis of chronic kidney disease is therefore very important, and can be done via simple tests to detect the level of kidney function.

In its early stages, the greatest risk to those suffering CKD is death from cardiovascular disease. This risk is thought to be at least ten times higher in patients with CKD than in those without, and can occur regardless of whether patients go on to develop kidney failure. As kidney function starts to deteriorate further, the risk of other complications start to increase, such as anaemia and renal bone disease. If it continues to progress, it can lead to ERF.

Identifying Chronic Kidney Disease

We therefore strongly support the need for early identification of CKD. There is increasing evidence that if detected early, the complications associated with CKD and progression to established renal failure can be delayed or even prevented by appropriate interventions.

This can be done via simple tests carried out on small samples of blood and urine to measure kidney function by calculating creatinine content and GFR. The National Service Framework for Renal Services recommends that this be conducted routinely with specific "at risk" groups, including patients with associated long-term conditions, as well as those with a family history or genetic risk of kidney disease.

This can be carried out in primary care, where GPs can monitor patients closely and work with them to reduce the risk factors associated with CKD, such as poor diet and lifestyle. There is also considerable scope in primary care for integrating the care pathways for diabetes and cardiovascular disease with that of CKD so that "at risk" patients are managed carefully and their chances of developing CKD are reduced.

For this reason, we greatly welcomed the recent inclusion of CKD in the Quality and Outcomes Framework of the General Medical Services Contract. This saw measures being introduced from April this year to identify and manage the disease in primary care. We are now keen to ensure that GPs implement these measures to help improve the rate of early detection and prevention of CKD.

Prevention of Progression

For patients already suffering from CKD, it is very important that they receive timely, appropriate and effective investigation, treatment and follow-up to reduce the risk of progression and complications. It is likely that some patients will already be receiving structured care for other, associated long-term conditions, such as heart disease and diabetes.

Specific measures to prevent the progression of CKD include steps to lower blood pressure, which has been shown to be effective in reducing the deterioration of kidney function. There are a number of treatments available for this, including diuretics that reduce the amount of salt and water in the body; beta-blockers, which reduce the effects of hormones such as adrenaline; and drugs such as ACE inhibitors (Angiotensin Coverting Enzyme) and ARBs (Angiotensin Receptor Blockers), which prevent the action of specific hormones that increase blood pressure. In the case of these latter drugs, they can be particularly beneficial to CKD patients with proteinurea (protein in the urine) in preventing further damage to the kidneys.

Alongside this, it is vital to address lifestyle factors that could help to reduce high blood pressure, such as adopting a healthy and varied diet, stopping smoking and exercising regularly. Importantly, this should include measures to reduce salt consumption.

For patients with CKD and diabetes, who are most at risk of death from cardiovascular disease, lipid-lowering treatment such as statins can also be beneficial, for those with CKD arising from urinary tract infection or obstruction.

Further information on the identification and early management of CKD in primary care can be found in our position statement on QoF and eGFR. Information on treatment modalities for more advanced CKD can be found in our position statement on Modalities in Stage 4/5 Chronic Kidney Disease.

Kidney Research UK

April 2007