Publication of the second part of the Renal National Service Framework (NSF) served to emphasise the change in focus in renal medicine from treatment of established kidney disease to earlier identification and prevention of kidney disease. Allied to this is the knowledge that late referral of people with advanced kidney disease to nephrology services from both primary and secondary care is still at least as high as 30%, engendering increased mortality and morbidity and precluding assessment and preparation of those for whom conservative management is more appropriate.
Over 2% of the total NHS budget is spent on renal replacement therapy (dialysis and transplantation) for those with established renal failure. Strategies aimed at earlier identification and (where possible) prevention of progression to established renal failure are therefore clearly required. Equally importantly, population studies have shown that people with diagnosed chronic kidney disease (CKD) have a far greater likelihood of cardiovascular death than progression to established renal failure. Furthermore, the majority of people with CKD are asymptomatic and may not even be aware that they have any form of kidney problem.
The challenge is to: identify people with or at risk of developing CKD; determine who needs intervention to minimise cardiovascular risk and to determine what that intervention should comprise; determine who will develop progressive kidney disease and/or complications of kidney disease and how they may be identified and managed to reduce/prevent these outcomes; determine who needs referral for specialist kidney care. This requires adoption of an overall health approach and an integrated care strategy involving public awareness, professional education, policy influence, and improved care delivery systems all under-pinned by research.
Copyright © 2008, Royal College of Physicians of London.