Chronic kidney disease is an underdiagnosed but increasingly common condition. Estimates suggest 4-9 per cent of adults experience the more advanced stages of the disease. The burden on the health service is growing, and 1-2 per cent of the NHS budget is now spent on dialysis alone, say David Meechan and James Hollinshead

In the second renal national service framework progress report, national director for kidney care Dr Donal O'Donoghue outlines improvements in detection of renal disease and patient care. He reports that these are still early days for implementing the framework, and the NHS is working to develop best practice, improve primary care and expand haemodialysis capacity.

Key to improving the management of the condition are the chronic kidney disease indicators, introduced to the GP quality and outcomes framework in 2005. These highlight the need for early identification and improved management of the disease. One indicator shows the number of patients on GP chronic kidney disease registers. This is used to estimate prevalence.

These figures for adults in individual GP practices in England are shown in the graph. They reveal a wide variation, with two peaks in the distribution. The first peak (0-0.5 per cent) suggests under-recording, which may be due to difficulties in the first year of data collection. The second peak includes the national average quality and outcomes framework prevalence 3 per cent, which is below the expected 4-9 per cent.

Accurate information on chronic kidney disease prevalence is essential for planning services. It means that commissioners can ensure resources are available where needed. This is vital because there are wide variations in the rates of people receiving renal replacement therapy across England.

The quality and outcomes framework information offers a good way forward in estimating need for renal services but, as illustrated, the data collected in the first year has limitations.

This will improve over time and progress has already been made. However, there is some way to go to achieve good coverage. Commissioners must consider this when using the information to estimate need and plan services for their areas.

In the interim, other prevalence estimates are needed. The Association of Public Health Observatories is developing disease prevalence models to complement and validate quality and outcomes framework prevalence data.

These will allow better prevalence estimates and enable commissioners to make more sense of current and future service use.

David Meechan is director and James Hollinshead is a specialist registrar in public health at the East Midlands Public Health Observatory, part of the Association of Public Health Observatories Network

www.apho.org.uk

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