Call to target kidney care costs

The health economics study, commissioned by NHS Kidney Care and published in summary in the peer-reviewed journal Nephrology Dialysis Transplantation, found that chronic kidney disease (CKD), a long term condition where the kidneys do not work as well as healthy ones, costs the NHS in England more than £1.4bn each year.

This is more than the spend on breast, lung, colon and skin cancer combined (£1.37 billion), according to the in-depth report published on the NHS Kidney Care website simultaneously with the journal.

Treating kidney disease and its complications takes £1 in every £77 spent by the NHS in England.

Nearly half of this sum is spent on dialysis or transplant for people whose CKD has progressed so far their kidneys fail.

Yet many people are not receiving help to tackle the disease in its earlier stages which could prevent the need for expensive dialysis or transplant.

Around 1.8m people in England have been diagnosed with CKD. However there are thought to be around a million more people who have yet to be diagnosed.

Failure to detect these people means they also don’t get the lifestyle advice and treatment they need.

The number of people receiving renal replacement therapy increased by 29% between 2002 and 2008. Total prevalence of CKD (diagnosed and undiagnosed) is also believed to be increasing.

As many as 29,000 people with chronic kidney disease (CKD) are not receiving essential medication to slow its progression, leading to worse health outcomes and a massive drain on NHS resources.

The progression of CKD can be slowed or even halted though lifestyle changes and medication. However, the study found that half a million people with CKD were not tested by their GP in 2009-10 to see if they would benefit from drugs.

Had they been, it estimates that a further 29,000 might have been prescribed ACEIs (Angiotensin Converting Enzyme Inhibitors) or ARBs (Angiotensin Receptor Blockers), saving the NHS around £13m a year through reduced need for dialysis and transplant and reduced stroke and heart attack risk.

Better diagnosis and earlier treatment significantly improves people’s quality of life, cuts their risk of heart attacks and stroke and minimises their likelihood of needing dialysis or transplant. It also saves NHS resources.

The study found that there are around 7,000 extra strokes and 12,000 extra heart attacks each year among people with CKD (‘extra’ means over and above those in people of the same age and gender without CKD).

The health care cost of these extra strokes and heart attacks is estimated at £174m to £178m a year. Social care for people who have had strokes adds an extra £130m to the total bill.

NHS Kidney Care, which supports NHS services to improve the care they provide, is urging GPs and other primary care clinicians to improve the detection and early treatment of CKD and has developed a range of professional resources to help them do this.

Beverley Matthews, Director of NHS Kidney Care, said: “Chronic kidney disease, if unchecked, can have a devastating impact on people’s lives and, as this study shows, it is also a major drain on NHS resources.

“Better detection and earlier treatment could help tens of thousands of people to lead better lives and free up precious resources to be used elsewhere in the NHS.

“Many GPs and primary care nurses are doing fantastic work to tackle this problem, and we are helping others with education and practical tools to improve care and treatment for people with chronic kidney disease.”