Chronic kidney disease (CKD) is a condition characterised by a gradual loss of kidney function over time. Around 1.9 million people in England have been diagnosed with moderate to severe CKD (stages 3-5), although it is thought that many more are undiagnosed. The annual costs to the NHS of caring for people with stage 3-5 CKD have been estimated as around £1.5 billion (Kerr 2012). People with stage 5 CKD experience end stage renal failure and will either require a kidney transplant or regular sessions of dialysis. Patients with CKD can readily be identified if pathology labs estimate GFR when they measure creatinine and there is strong evidence that good blood pressure control in patients with CKD alters their outcome.
The prevalence of patients with stage 3-5 CKD, based on GP practice registers reported through Quality Outcomes Framework, has remained steady between 2008/09 and 2015/16, ranging from 4.1% and 4.3%. Prior to this, prevalence increased substantially between 2006/07 (2.4%) and 2008/09 (4.1%). This likely reflects increased numbers of diagnoses being made due to raised awareness of CKD and better recording of status. Much of this will have been related to the introduction of CKD measures in the QOF programme.
It is important that blood pressure is monitored and managed effectively as high blood pressure is a leading cause and symptom of chronic kidney disease (CKD)(Kidney.org.uk), CKD.
Following a fall from 86.9% in 2006/07 to 74% in 2007/08, the percentage of CKD patients whose blood pressure is below the recommended threshold (140/85) has been increasing slowly. In 2014/15, 81% of patients had blood pressure below 140/85. The percentage of patients that have hypertension and proteinuria who are given appropriate treatment (with an angiotensin converting enzyme inhibitor or angiotensin receptor blocker) has remained relatively steady over time, with 91.8% in 2009/10 and 91.5% in 2014/15.
A minority of people with CKD will experience end stage renal disease and require regular sessions of either haemodialysis (HD) or peritoneal dialysis (PD). The achievement of a urea reduction ratio (URR) of more than 65% is associated with a reduced risk of complications, hospitalisation and death. The percentage of patients for which this is being achieved has been rising steadily since 2006 and was at 88% in 2011. Renal failure and dialysis also increase the risk that the patient will develop anaemia. Best practice guidance recommends that dialysis patients’ haemoglobin levels should not fall below 10 g/dl. The percentage of patients for which this level is achieved has been falling steadily for both HD and PD patients since 2006. The 2008 report of the UK Renal Registry suggests that the introduction of a recommended upper limit for haemoglobin (12 g/dl) in patients with severe cardiovascular disease – and the struggle to comply with both limits – has impacted performance on this measure.
The number of kidney transplants from both living and deceased donors has been steadily increasing for many years. Since 2008/09, there has been a 23% increase in the number of transplants from deceased donors, which was partly due to transplants after circulatory death becoming more common. Transplants from living donors increased by 12% in the same period, and in 2012 this represented one third of all kidney transplants. Most are donated to a specific recipient known to the donor – typically a close family member or friend – but there have been notable increases in the number of altruistic donations (a person offers to donate to someone who needs a transplant but whom they have not known previously) and paired exchange living donations. The increasing number of transplants means that the number of patients on the national list for a kidney transplant has been falling since 2008.
About this data
Some of the data reported here have been supplied by the UK Renal Registry of the Renal Association. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the UK Renal Registry or the Renal Association.