Patient safety - hydration matters
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Kidney disease costs the NHS more than breast, lung, colon and skin cancer combined, yet too many cases remain undiagnosed and untreated, according to a report published today by NHS Kidney Care.
The report, which is summarised today (6 August) in in the medical journal Nephrology Dialysis Transplantation has found that chronic kidney disease (CKD) costs the NHS in England more than £1.4bn each year.
This is more than the combined NHS spend on breast, lung, colon and skin cancer (£1.37 billion), according to the full-length study Chronic Kidney Disease in England: The Human and Financial Cost
Treating kidney disease, including complications such as heart disease and stroke, swallows up £1 in every £77 spent by the NHS in England.
Nearly half of this sum is spent on renal replacement therapy, yet many people are not receiving help to tackle the disease in its earlier stages when it could prevent the need for expensive dialysis or transplant.
Around 1.8m people in England have been diagnosed with CKD; however there are thought to be around a million more people with CKD who have yet to be diagnosed.
Failure to detect these people means they also don’t get the lifestyle advice and treatment they need.
The number of people receiving dialysis or transplant increased by 29 per cent between 2002 and 2008. Total prevalence of CKD (diagnosed and undiagnosed) is also believed to be increasing.
The report also estimated that nearly 30,000 people with CKD are not receiving essential medication to slow its progression, leading to poorer health outcomes and a massive drain on NHS resources.
The study found that half a million people with CKD were not tested in 2009-10 to see if they would benefit from ACEI (Angiotensin Converting Enzyme Inhibitor) or ARB (Angiotensin Receptor Blocker) drugs.
Had they been, it estimates that a further 29,000 people might have been prescribed these drugs, which would improve health outcomes and save the NHS around £13m a year.
Earlier diagnosis and treatment significantly improves people’s quality of life, cuts their risk of heart attacks and stroke and minimises their likelihood of needing dialysis or transplant. It also saves NHS resources.
The study found there are around 7,000 extra strokes and 12,000 extra heart attacks each year among people with CKD (‘extra’ means over and above those in people of the same age and gender without the condition).
The health care cost of these extra strokes and heart attacks is estimated to be up to £178 million a year. Social care for people who have had strokes adds an extra £130 million to the total bill.
NHS Kidney Care is urging GPs and other primary care clinicians to improve the detection and early treatment of CKD, and has developed a range of professional resources to help them do this.
Beverley Matthews, Director of NHS Kidney Care, said, “Chronic kidney disease, if unchecked, can have a devastating impact on people’s lives and as this study shows, it is also a major drain on NHS resources.
Better detection and earlier treatment could help tens of thousands of people to lead better lives and free up precious resources to be used elsewhere in the NHS.
“Many GPs are doing fantastic work to tackle this problem, and we are helping others with education and practical tools to improve care and treatment for people with chronic kidney disease.”
Dr Donal O'Donoghue, National Clinical Director for Kidney Care, said, “This report from the NHS Kidney Care team is a wake-up call for everyone involved in the fight against kidney disease. As a kidney doctor for over 25 years, one of the most enduring themes has been missed opportunities to identify kidney disease early.
“This report shows that with the cost of caring for people with kidney disease exceeding some of the most common cancers combined, the NHS has to help clinicians find ways to identify and treat chronic kidney disease at an earlier stage.
“Failing to do so means we are unable to prevent complications. It also stops us planning for the future care of patients, and wastes precious NHS resources.
“Putting the cost of care aside, for individual patients the late identification of kidney disease means delays in diagnosis with a failure to manage risk factors including heart attacks, strokes and progressive kidney disease.
“This can lead to starting dialysis in an unplanned way, with increased stays in hospital, ill-health and fatalities.”
NHS Kidney Care has produced a range of resources to support healthcare professionals to improve care for people with CKD, including:
View the summary article in Nephrology Dialysis Transplantation
Patient safety - hydration matters