INFORMATION RESOURCES ON KIDNEY DISEASE AND SERVICES
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Introduction
The East Midlands Public Health Observatory (EMPHO) is the lead Public Health Observatory for kidney (renal) disease and services. To support this role these theme pages provide some background to kidney disease and list useful resources and links both from Public Health Observatories and other sources.
EMPHO also has a joint work programme with NHS Kidney Care. A number of products and tools have been developed within this work programme and these are also signposted within the web pages.
Kidney disease is an important public health issue. It is common and the prevalence increases with age, which means that the disease burden will increase with our aging population. Chronic kidney disease (CKD) is an independent risk factor for other diseases, particularly cardiovascular disease. It often coexists with other cardiovascular conditions meaning that it needs to be managed alongside other conditions such as diabetes and hypertension.
A wide range of disease processes can damage kidney function. Where there is rapid loss of function (as in acute renal failure) recovery may be complete or leave some degree of chronic deficit. Kidney function may also be affected by chronic disease processes, accelerating the slow deterioration that comes with age (causing chronic renal failure).
CKD is internationally classified into five different stages following guidance from the US National Kidney Foundation1; stage five relates to the most severe form of kidney disease whilst stage one is the least severe. Estimates of glomerular filtration rate (GFR) - a measure of the flow rate through the kidney - are used to determine levels of CKD. This classification has been refined by the NICE guidance on CKD management.2 Stage 3 CKD has been further subdivided into stages 3a and 3b as outlined in the following table.
Stages of chronic kidney disease
Stage* |
GFR (ml/min/1.73 m2) |
Description |
1 |
> 90 |
Normal or increased GFR, with other evidence of kidney damage |
2 |
60–89 |
Slight decrease in GFR, with other evidence of kidney damage |
3A |
45–59 |
Moderate decrease in GFR, with or without other evidence of kidney damage |
3B |
30–44 |
4 |
15–29 |
Severe decrease in GFR, with or without other evidence of kidney damage |
5 |
< 15 |
Established renal failure |
* Use the suffix (p) to denote the presence of proteinuria when staging CKD.
Source: Taken from the NICE CKD guidelines2.
In a minority of cases, CKD progresses to end stage renal disease (ESRD), which may require renal replacement therapy (RRT). This progression can be reduced if it is identified and managed; early diagnosis is therefore essential.
ESRD is an irreversible long-term condition. Until the 1960’s ESRD always resulted in death3 because kidney function is essential for life.4 People with renal failure (CKD stage 5) usually require some form of RRT such as peritoneal dialysis, haemodialysis or renal transplant, although conservative management is also an option.
In 2008 an estimated 5,585 patients were accepted for RRT in England, an incident rate of about 109 per million population. There were 39,476 patients receiving RRT in total in England in 2008, a prevalence rate of 767 per million population. Overall growth in the prevalent England RRT population from 2007 to 2008 was 4.5%5.
There are variations in treatment rates by region within the UK that are not fully explained by demographic differences. Some of the variation between Local Authority area rates has been attributed to ethnic mix. South Asian and African Caribbean people are 3 to 5 times more likely to have kidney failure than White Caucasians.6 However, in 2008 in England the crude acceptance rates in Local Authorities varied from 36 to 243 per million population.5 The degree of variation suggests that other factors such as variable thresholds for treatment and access may be playing a part in determining treatment.3
Further data on care provided in the UK can be obtained from the UK Renal Registry.
References
- K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. URL: www.kidney.org/professionals/Kdoqi/guidelines_ckd/p1_exec.htm
- National Institute of Health and Clinical Excellence. CG 73. Chronic Kidney Disease: Early identification and management of chronic kidney disease in adults in primary and secondary care. September 2008. Accessed Aug 2010, URL: http://www.nice.org.uk/Guidance/CG73)
- DH Renal NSF Team. The National Service Framework for Renal Services Part One: Dialysis and Transplantation. 2004. London, Department of Health.
- NEPHO. Occasional Paper 05 - Implementation of the Renal NSF in the North East and Cumbria. Downloaded 06.07.08 URL: www.nepho.org.uk/
- Ansell D, Castledine C, Feehally J, Fogarty D, Ford D, Inward C, Tomson C, Warwick G, Webb L and Williams A. The Renal Association, The UK Renal Registry. The twelfth annual report. December 2009. Downloaded 18.10.10 URL: http://www.renalreg.com/Reports/2009.html
- Lightstone, L. Preventing Kidney Disease: the Ethnic Challenge in the UK. Kidney International (2003) 63, S135–S138; 1523-1755.
The hyperlinks in these web pages take you directly to the resource. These hyperlinks were correct at the time of publication; if they no longer work because changes have been made to external websites, you should visit the relevant home page to search for the document.
If you have any queries on the renal disease and services home page please contact
.
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PAGE CREATED: 5 November 2010 | PAGE REVISED: 15 November 2011