London and Surrey kidney facts and figures

London kidney facts| Equity audit | LKN compared to national average |

London and Surrey kidney facts

Seven Renal Units

• Barts Health NHS Trust
• Imperial College Healthcare NHS Trust
• Royal Free London NHS Foundation Trust
• Epsom and St Helier University Hospitals NHS Trust
• St Georges University Hospitals NHS Foundation Trust
• Kings College Hospital NHS Foundation Trust
• Guy’s and St Thomas’ NHS Foundation Trust

Providing kidney services across 32 London Boroughs & Surrey

Links to data page

and links to individual workstream pages and expert groups.

London Kidney Network equity audit: key findings

Equity of access, quality and outcomes – baseline assessment (pre-COVID, adults)

Download our full LKN Health Equity Audit findings.

Age:

The risk of developing kidney disease and also requiring Renal Replacement Therapy (RRT) increases with age, with a peak in the 75-84 year age band with a median age of 64 years. (1,2)

The burden of RRT service provision (in terms of numbers) falls mostly within the 45-74 year age band. The median age for the prevalent RRT population is 60 years (2)

Ethnicity:

Crude incidence rates for RRT are higher amongst Black and Asian ethnic groups (2). Evidence for ethnic differences in CKD progression and outcomes is mixed (3). Evidence for poorer access to healthcare services in general for BME groups is reported (4).

Socio-economic status:

Crude incidence rates for RRT are higher amongst patients who live in areas categorised as more deprived (2). Evidence from research demonstrates that those who are social deprived are more likely to develop CKD than their less disadvantaged counterparts (5)

Clinical risk factors:

High blood pressure is both a leading cause of and complication of CKD. It increases the chance that kidney disease will get worse (6).

Diabetes is the leading cause of kidney failure, An estimated 40 per cent of people with both type 1 and type 2 diabetes will develop CKD during their lifetime (7)

Early stage CKD is clearly a risk for developing more advanced disease as well as being a risk factor for AKI. Albuminuria is a risk factor for faster progression of CKD as well as renal failure and CVD (8)

Frailty is prevalent in patients with CKD and it is associated with an increased risk of adverse health outcomes (9)

Mental health disorders or more common among people living with kidney disease  which has consequences for their ability to adhere to treatment plans (10)

Heart failure is a significant risk factor for kidney disease (11)

Population Risk Factors

Population from an ethnic group other than white

The map below demonstrates the distribution of people of different ethnicity across London (the darker colours indicate a higher % from ethnic groups other than white).

Socio-economic status (deprivation: based on the Index of Multiple Deprivation)

Overall, London has a similar level of deprivation to that of England as a whole. The number of neighbourhoods (LSOAs) in London among the most deprived 5% in England is eight out of a total of 4,835 LSOAs in London, or 0.2 per cent of London’s LSOAs. There are a further two per cent more (99 LSOAs) in England’s most deprived 10%.

However, in terms of relative deprivation within London, East London has a higher proportion of it’s population that live in areas categories as amongst the most deprived in the country. Surrey Heartlands and South West London are comparatively less deprived than the rest of London (and England as a whole).

The University of Sheffield, in collaboration with the Ministry of Housing, Communities and Local Government have produced IMD maps by Local Authority which can be downloaded here

The burden of clinical risk factors

The charts show the estimated number of people to be living with CKD stage 3-5, Diabetes or Hypertension by ICS (both diagnosed and undiagnosed). These data have been estimated from national survey sources. We do not have actual data on the true prevalence of these conditions at sub-national geographies and so estimates of risk (%) cannot be shown. However, the burden (i.e. the estimated number of people) of these conditions is still of interest for service funding and planning purposes.

It can be seen that the pattern between ICSs is generally driven by a function of population size, with the more populous ICS areas having the biggest burden. The age structure of the population has been taken into account in these estimates but other factors have not, such as ethnicity and deprivation. Therefore, these estimates should be interpreted alongside the ethnicity and deprivation information on previous slides.

The burden of clinical risk factors (continued)

The charts show the estimated number of people to be living with frailty (multi-morbidity), Heart Failure or Mental Illness by ICS (both diagnosed and undiagnosed). These data have been estimated from national survey sources. We do not have actual data on the true prevalence of these conditions at sub-national geographies and so estimates of risk (%) cannot be shown. However, the burden (i.e. the estimated number of people) of these conditions is still of interest for service funding and planning purposes. The age structure of the population has been taken into account in these estimates but other factors have not, such as ethnicity and deprivation. Therefore, these estimates should be interpreted alongside the ethnicity and deprivation information on previous slides.

It can be seen that the pattern is generally driven by a function of population size, with the more populous ICS areas having the biggest burden. Although this is not always the case, for example, North East London is estimated to have a high burden of mental illness relative to population size.

Learning Disability Primary Care Registers

Data in the LKN

At the heart of decision-making and improvement planning 

We are developing our approach to focus on improving the use of data to inform decisions and ensure that we directly target health inequalities in the kidney pathways of care.

Creating an LKN Dashboard

Sharing robust data is key to showing difference and hence identifying good practice and areas of unwarranted variation.

• We developed a comprehensive data dashboard which was first published in December 2021 using agreed metrics, by workstream, at Trust level.  It currently pulls data from existent sources into one place.
• This will be further developed early in 2022/23 to show ICS level data.
• The LKN Clinical Information Group (CIG) will develop this yet further to include additional workstream metrics

GIRFT/RSPT Mapping Report

We mapped the LKN workplans against Renal Service GIRFT Report and the RSTP to ensure we:

• addressed all priority actions for networks in year and into 2022/23
• work collaboratively with and responsively to national  data workstreams e.g. RSTP
• address unit level responsibilities though our workstreams and so:
• minimiserepetition
• share learning, and provide a pan-London solution to issues

Primary Care Network level data for pilots

As part of the CKD pilot development, we needed to show at PCN level where there was greatest variation in actual against expected CKD prevalence and medical management against guideline standards.

Working collaboratively with our partners in NHSE/I data presented in a RAG format, provided a clear basis for inclusion with the in the planned pilot project. We identifed PCNs with most potential to: improve CKD outcomes for patients; reduce variation; and slow growth in demand for RRT.