Identifying the missing thousands with undiagnosed chronic kidney disease

A GP measuring a patient's blood pressure.

What did we do?

Our chronic kidney disease (CKD) projects support GP practices to improve identification and management of people with early stage CKD.

It’s been identified that there are fewer people in Greater Manchester diagnosed with CKD than the expected prevalence suggests there should be, meaning that people who have CKD may not be getting the best care and treatment. End stage CKD is growing at 6% every year and poses a huge financial cost for the NHS: diagnosing and treating this disease effectively as early as possible is hugely important.

The burden of CKD is severe: patients have a greatly increased risk of suffering a stroke, heart attack, renal failure or death.

A GP with a patient.We first ran this project between 2009 and 2013 (during the first round of our funding cycle). Phase one of the initial project identified 1,324 additional patients with CKD across 19 GP surgeries, and 74% were treated to recommended blood pressure targets. Phase two identified 539 additional patients with CKD across 11 GP surgeries, and 83% of them were treated to recommended blood pressure targets. Phase three identified 296 additional patients across 12 practices, with 71% treated to recommended blood pressure targets.

From January 2013, we started to work across three localities in NHS Central Manchester Clinical Commissioning Group (CCG), and from 2014 with practices in NHS Bury CCG to spread the  IMPAKT™ audit tool, an integrated package of CKD implementation resources.

Phase one of this project involved 7 practices. The practices identified 188 additional CKD patients and managed 76% of their patients on the CKD register to National Institute for Health and Care Excellence (NICE) blood pressure guidelines. Phase two included 9 practices; these practices identified 368 additional patients, and 72% of CKD patients had blood pressures managed to NICE guidelines.

Key outcomes and impacts

  • Between 2009 and 2014 a total of 2,715 additional patients with CKD were identified across 58 GP surgeries in Greater Manchester as a result of this work
  • 77% of people diagnosed with CKD were tested for proteinuria and had their blood pressure controlled to NICE recommended targets
  • A CKD audit tool was imported to support the implementation of the second CKD project within the programme. A collaboration followed with the original designers to produce a comprehensive CKD improvement support website. IMPAKT™ hosts the audit tool with a range of supporting resources, enabling practices nationwide to make improvements to their CKD registers both within and outside of NIHR CLAHRC Greater Manchester facilitated projects.

What next?

Work is continuing in NHS Central Manchester and NHS Bury CCGs. The next stage of this work is a proteinuria evaluation – proteinuria is the presence of abnormal quantities of protein in the urine, which may indicate damage to the kidneys. The evaluation will investigate the management of CKD patients with proteinuria (NICE blood pressure targets are stricter for CKD patients with proteinuria and so are harder to achieve, but getting these patients’ blood pressure to target can help to stop the progression of CKD).

More information

For more information about this work please contact Lorraine Burey, Project Manager.