Chronic kidney disease (CKD) is a common long-term condition that can cause serious health complications. Preventing CKD and treating CKD have been a high priority for the government, Department of Health and NHS for many years.
Identifying the condition at an early stage and slowing down its progress is key to reducing the impact of CKD on people’s lives. This is just as important as ensuring that people with more advanced disease get the high-quality, cost-effective care they deserve.
National standards for people with kidney disease have already led to improvements, but more needs to be done. It is hoped that together the National Service Framework, NHS Outcomes Framework and NICE quality standards will help the NHS carry on improving the quality of healthcare through early diagnosis of kidney disease, improving choice, ensuring joined-up care and improving outcomes.
NHS Kidney Care also plays a vital role in supporting the drive towards high-quality, affordable care for people with kidney disease.
About chronic kidney disease
In chronic kidney disease, the kidneys do not work properly any more. The kidneys are essential for cleaning toxins from the blood. CKD does not usually cause any symptoms until it has reached an advanced stage. Find out more about how CKD is diagnosed.
A large proportion of people with CKD have other long-term conditions, and this proportion increases with age. Complications of CKD include:
Anaemia is a relatively common complication of CKD. It is estimated that around 100,000 people in the UK have CKD and a low haemoglobin level (a protein that transports oxygen in the blood). The NICE guidelines on anaemia management in people with chronic kidney disease cover detecting and diagnosing anaemia of CKD, and managing anaemia of CKD and other health problems or treatments that may affect it.
In some people, CKD may cause kidney failure, also known as established renal failure or end-stage kidney disease. This is an irreversible decline in kidney function. At this stage, people will need to have renal replacement therapy in order to stay alive. This could be a kidney transplant, dialysis or conservative kidney care. Transplants are often more successful if the organ comes from a living donor, or if they are carried out before there is a need to start dialysis.
If the condition is diagnosed at an early stage, further damage to the kidneys can be prevented with a combination of lifestyle changes and medication. These changes can also reduce the risk of a stroke or heart attack.
Preventing and treating CKD
Promoting a healthy lifestyle, helping people stop smoking and reducing high blood pressure by cutting down on salt, getting more active and avoiding obesity are key factors in preventing CKD.
The Change4Life campaign was launched in 2009. This is part of a strategy to help reduce obesity, which can lead to type 2 diabetes and CKD, and to help people maintain a healthy weight. Aimed at families, it promotes messages around healthy eating and being more active.
The NHS Health Check programme
Vascular disease (heart disease, stroke, diabetes and kidney disease) affects the lives of more than 4 million people and kills 170,000 in the UK every year. Research by the Department of Health found that offering the NHS Health Check to everyone aged 40 to 74 in England, and recalling them every 5 or 10 years, would be cost effective and have clinical benefits.
The NHS Health Check assesses people’s risk of heart disease, strokes, kidney disease and diabetes by looking at their age, gender, family history, height and weight, as well as their blood pressure and cholesterol levels.
Everyone will receive a personal assessment, setting out their levels of risk and how to reduce it. For people at low risk, this might be no more than general advice on how to stay healthy, weight-management programmes or stop-smoking services. People at the highest risk may also require preventative medication with statins or blood pressure treatment.
NHS Health Checks have the potential to prevent 1,600 heart attacks and strokes and save up to 650 lives each year. They could prevent over 4,000 people a year from developing diabetes and detect at least 20,000 cases of diabetes or kidney disease earlier.
Management and services for people with CKD
Good management of patients with kidney disease can slow, halt or reverse chronic kidney disease. Most cases of mild kidney disease are managed in primary care, for example by GPs or practice nurses.
Advanced kidney disease is generally managed in secondary care, such as in hospitals. Hospital-based dialysis can take place in facilities that contain renal units, or in satellite centres which are run alongside these main units.
The provision of renal replacement therapy through these centres is constantly monitored. New centres are being added to ensure that the service is accessible to those who need it. It is recommended that patients should be able to access dialysis services within a 30-minute drive. The Kidney Care Network map on the NHS Kidney Care website has details of all the renal units in England.
Shared decision making and choice
Renal PatientView (RPV) is a Renal Information Exchange Group (RIXG) project that provides online information about kidney patients' diagnosis, treatment and latest test results from their hospital renal database. Patients can share this information with anyone they want, and view it from anywhere in the world. Renal PatientView is only available from some UK renal units for patients who have chosen to take part. The programme also allows patients to upload their blood pressure, weight and glucose measurements and comment about their condition in a blog.
Haemodialysis at home is a good option for some people. It is recommended that all suitable patients should be offered the choice between home haemodialysis and haemodialysis in a hospital or satellite unit. In general, patients who have home haemodialysis report better quality of life than those who have haemodialysis in hospital. There are fewer issues with travel, waiting in hospital for treatment and changing timings to reduce the impact on a person's life. NHS Kidney Care has produced a guide for kidney patients on home haemodialysis.
Peritoneal dialysis is a less well known type of dialysis, but it's becoming more common. It involves using the peritoneum as a filter. Peritoneal dialysis is usually recommended for adults who are otherwise healthy apart from having kidney disease.
Both types of dialysis can be carried out at home, which means you don't have to visit hospital or a dialysis unit. The process of peritoneal dialysis lasts roughly 30 to 40 minutes and is repeated around four times a day. Alternatively, you can run it overnight.
In many instances the choice of which type of dialysis you use is up to you. However, there are some medical problems that can mean a method is unsuitable or less suitable (for example, a previous major operation on your abdomen).