Dr Chris Lawrence, clinical lead for renal care at Xyla, uncovers how adapting perspective on Chronic Kidney Disease could save the NHS millions of pounds and thousands of lives
As of last year, Chronic Kidney Disease (CKD) is said to affect over seven million people in the UK. With cases set to rise over the next decade, CKD presents a nationwide public health issue that brings major economic strain to our healthcare system. In 2023 alone, kidney disease cost the UK economy £7 billion, a figure that some economic models predict could spiral to £13.9 billion by 2033, with increased demand for late-stage treatment including expensive procedures like dialysis and transplantation.
This expense is not unavoidable. Research from Kidney Research UK highlighted that the cost of managing CKD can be significantly reduced through early detection, pharmacological intervention and public outreach – saving the UK economy over £440 million over the next ten years.
But why has CKD become such a prevalent danger to the nation’s health and economy? The answer lies in a web of interrelated factors which collectively drive the increase in CKD. The UK’s ageing population is a large contributor, with CKD risk significantly increasing with age. This is combined with other health-related risk factors such as diabetes, hypertension, and cardiovascular disease – all of which are relatively common and exacerbate the chances of developing kidney disease. We’re also still seeing the developing impacts of the Covid-19 pandemic, with cases of hospitalised patients developing acute kidney injury which can progress to CKD.
Considering the pervasiveness of CKD in the UK, we must ask ourselves why most cases are left until the latter of the disease’s five stages before providing medical intervention. Low kidney function is one of the main drivers of risk for progressive loss of kidney function. Patients reaching stage 5 CKD may require renal replacement therapy (RRT), costly procedures including dialysis and transplantation. Dialysis alone costs the NHS £1 billion and, according to Kidney Research UK, has the potential to rise to £4.9 billion by 2033. Such direct costs not only divert funding and clinical capacity away from other critical NHS services, but also cost the UK economy indirectly through lost productivity which, alone, is predicted at an annual loss of £372 million.
To soften such a financial blow, the NHS must place greater priority on earlier diagnosis of CKD to prevent patients from progressing through more advanced stages of CKD and therefore reducing the cost and burden of care and, most importantly, preventing patients from reaching the requirement for renal replacement therapies. This is especially the case for those of lower socio-economic status where CKD is more prevalent and there are greater barriers to accessing the care required.
Earlier CKD diagnosis can be compounded with better management of the disease for those who have been identified. Particular drugs that are used to control blood pressure have shown great benefits in reducing cardiovascular events and CKD progression. Despite this, Kidney Research UK states that little over half of those eligible in the CKD population are receiving such drugs. Improving consistency of prescribing these medications alone would reduce the likelihood of progressing through the stages of CKD.
Similarly, Sodium-Glucose Transporter 2 Inhibitors have proven great benefits in delaying the progression of kidney disease and reducing cardiovascular events in those with CKD with or without diabetes. Projections carried out with optimisation of SGLT2 inhibitor prescribing showed a reduction of just under 2,000 people needing dialysis and 5,600 deaths over a ten-year period compared to the base case (without the use of SGLT2i).
With technology-enabled personalised care and medical intervention with SLGT2i medication, the NHS could save, NHS could save over 10,000 lives and £446 million between 2023-2033, making considerable steps towards a long-term shift in how CKD is perceived and managed, in the face of an ageing population and the critical need for more efficient use of NHS resources.
From a financial and clinical perspective, the UK cannot afford to ignore CKD in its early stages. A considerable change is needed in how we tackle this public health issue as, without it, case numbers and their respective costs are only set to rise over the next decade. With an overall backlog of 7.6 million patient episodes, the NHS already faces enough stress in 2024, so what can be done, must be done.
