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National service frameworks and strategies

Setting standards in kidney care

Chronic Kidney Disease (CKD) is a common long term condition that is mild in the majority of those affected but 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.

Also read the report Kidney Health: delivering excellence (PDF, 7.5Mb), which lists and describes 16 future ambitions for kidney care. 

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.

All stages of CKD are associated with an increased risk of diseases of the heart and arteries. Only when CKD is more advanced does it have further consequences. Complications of CKD include:

Anaemia is a relatively common complication associated with advanced stages 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 a minority of 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 transplantdialysis 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

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.

Together, the vascular conditions identified by the NHS Health Check are the biggest cause of preventable deaths in the UK, affecting more than 4 million people.
Every year, the NHS Health Check is expected to help:

  • save 650 lives
  • prevent 1,600 heart attacks and strokes
  • prevent 4,000 people from developing diabetes
  • detect at least 20,000 cases of diabetes or kidney disease earlier

Find out more about the NHS Health Check.

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 containing 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.

Shared decision making and choice  

Shared decision making (SDM) is the conversation that happens between a patient and their health professional to reach a healthcare choice together. This conversation needs patients and professionals to understand what is important to the other person when choosing a treatment (Right Care 2012). You should ensure you receive the appropriate information that allows you to make an informed decision about your care.

Once you are under the care of the specialist kidney services you can ask to have access to Renal Patient View (RPV). RPV enables you to access online information about your diagnosis, treatment, latest blood test results and clinic letters. You can share this information with anyone you chose (including your GP), and view it from anywhere in the world. Renal Patient View is available from most UK renal units for patients. The programme also allows you to upload your own blood pressure, weight and glucose measurements, which you may have taken at home and comment about your 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 (the membrane lining the abdominal cavity) 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).

The National Service Framework (NSF) for renal services

The NSF for renal services is a clinical strategy to improve the outcomes and experiences of people with kidney disease. It was published in two parts and sets out standards for kidney care and good practice.

Part one: dialysis and transplantation

This part focuses on people who have established kidney failure. It sets out five standards and identifies 30 markers of good practice to help the NHS and its partners deliver more patient-led dialysis and transplant services which are fair and improve choice and quality for patients. This involves helping people with established renal failure get the information and support they need to make informed choices about their care, as well as giving them a personalised care plan which:

  • describes how they will be prepared for dialysis or transplantation
  • records their treatment preferences
  • outlines arrangements for their timely and appropriate surgery

Download part one of the NSF for renal services (PDF, 324kb).

Part two: chronic kidney disease, acute renal failure and end-of-life care

CKD affects a much larger group of people, many of whom do not know they have the condition. This part of the NSF focuses on ways to help NHS organisations:

  • prevent CKD in people at risk
  • develop strategies for identifying people with the condition and slowing down the progression of their disease
  • reduce the occurrence of acute renal failure (also called acute kidney injury), a potentially fatal disease that often requires treatment in an intensive care unit
  • ensure that all kidney patients nearing the end of their lives can get appropriate care and support

Download part two of the NSF for renal services (PDF, 206kb).

NICE quality standards for chronic kidney disease

NICE has published the chronic kidney disease quality standard. This gives an authoritative definition of good quality care. NICE quality standards enable the following to happen:

  • Health and social care professionals can make decisions about care based on the latest evidence and best practice.
  • Patients can understand what service they can expect from their health and social care providers.
  • NHS trusts can quickly and easily examine the clinical performance of their organisation and assess the standards of care they provide.
  • Commissioners can be confident that the services they provide are high quality and cost effective.

NICE has also developed a clinical guideline about acute kidney injury, the sudden loss of kidney function that usually occurs as a result of other illness (such as infection or dehydration).

The NHS Outcomes Framework

The NHS Outcomes Framework 2011/12 aims to ensure that the NHS achieves health outcomes that are among the best in the world.

The purpose of the framework is to:

  • provide a national overview of how well the NHS is performing, wherever possible in an international context
  • provide an accountability mechanism between the Secretary of State for Health and the NHS Commissioning Board
  • drive improvements in quality throughout the NHS by encouraging a change in culture and behaviour, including a renewed focus on tackling inequalities in outcomes

The Framework is structured around five areas:

  1. preventing people from dying prematurely
  2. enhancing quality of life for people with long-term conditions
  3. helping people recover from episodes of ill health or after injury
  4. ensuring that people have a positive experience of care
  5. treating and caring for people in a safe environment and protecting them from avoidable harm

 Within each area, there is:

  • a single or small number of comprehensive measures that can be used to assess how well the NHS is performing within this area
  • a small set of areas for improvement, which highlight where things could be done better to improve patient health 
  • a supporting set of NICE quality standards, which outline what high-quality care is for a particular programme of care

For more information, download the NHS Outcomes Framework 2011/12 (PDF 1.18Mb), from the Department of Health website.

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Page last reviewed: 28/03/2014

Next review due: 28/03/2016

Chronic kidney disease key facts

Approximately 6% of the UK adult population has chronic kidney disease (CKD) stages 3-5.  However it is important to recognise that the majority have mild to moderate kidney disease (stage 3 CKD) which is managed in primary care. Less than 0.2% of the population has stage 4-5 CKD which needs specialist care in hospital.

As many as 20% of people admitted to hospital as an emergency have acute kidney injury.

A large proportion of people with CKD also have other conditions, particularly cardiovascular disease.

High blood pressure, diabetes, obesity, smoking and socio-economic status are all risk factors for kidney disease.

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