Preventing Progression
What is the purpose of this workstream?
We work together with our partners to transform CKD diagnosis and care across London and Surrey Heartlands. We strive to improve outcomes for people living with kidney disease through early identification, accurate coding, and optimising care to prevent progression thereby protecting the kidneys and saving lives.
Workstream chairs
Kieran McCafferty
Clinical Co-Chair, CKD Prevention Workstream, Nephrologist, Barts Health NHS Trust
Linda Tarm
Clinical Co-Chair, CKD Prevention Workstream
“The LKN CKD Prevention Team have brought together healthcare professionals and patients across London to produce practical guidance and resources for primary care teams to improve how they identify, code and optimise care for people with CKD.”
Linda and Kieran
Prevention in London
There are ~86,000 adults living in London with undiagnosed Chronic Kidney Disease (CKD).
This exposes them to increased risk of cardiovascular events, worsening kidney function and end-stage kidney disease. These dire outcomes could be greatly reduced through early CKD identification, appropriate/consistent coding of CKD and effective evidence-based management strategies.
Early identification requires greater testing of Albumin Creatinine Ratio (ACR). The National Diabetes Audit (NDA) 2019/20 reported that across London, 71% of those with type 2 diabetes had received an ACR test, compared to 82% for those in the top performing decile.
Formal CKD diagnosis coding in primary care must be improved. In the national CVD-Prevent audit, ~34,000 of adults (registered with GPs) in London had evidence of CKD stage G3a to G5 but did not have a formal diagnosis of CKD.
We are in a new era of CKD treatment with multiple new agents established and in development, which could transform the outlook of people with CKD.
By investing in primary care, early identification tools/resources, teams and incentives to deliver effective interventions, there is an opportunity to deliver improved outcomes, including protecting the kidneys and heart, and a better patient experience.
Now is the time to act.
We have an opportunity to support GP practices to identify, code and manage CKD early to prevent or delay progression and protect the kidneys.
Aims and objectives of the group:
Aims:
1. Support primary care to identify, code, and manage CKD early in people with or at risk of CKD, in order to:
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- Prevent or delay progression
- Reduce the number of people reaching End-Stage Kidney Disease
- Reduce the risk of cardiovascular complications
2. Reduce unwarranted variation in CKD identification, coding and management across primary care and secondary care
3. Support the appropriate expansion of SGLT-2 inhibitors (SGLT2i) use as a cardio-renal protective agent
Objectives:
Through ICS and pan-London collaborations:
1. Explore and understand variation in CKD detection, coding and recording in primary care
2. Quantify prescription rates of SGLT2i in people with proteinuric CKD, with and without type 2 diabetes (T2DM), to describe current use
3. Identify and implement ways to optimise CKD detection rates, CKD coding, and reduce unwarranted variation
4. Identify and implement ways to increase SGLT2i use in proteinuric CKD patients with and without T2DM in primary care
” I have been a patient at Guy’s hospital since 2013 when I unexpectedly crash landed onto Guy’s renal wards and was diagnosed with stage 4 CKD. Since then I have experienced only a slow deterioration in my kidney function and have lived a happy, active, healthy life. WIth my experiences of running my own adult swim coaching business, combined with my own kidney journey, I am inspired to help improve LKN’s prevention processes. I hope that in doing so, others can also take an active approach to their kidney health management, delaying end stage renal failure for as long as possible too”
Workstream Members
Published guidelines:
Pathways
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- LKN CKD Early Identification Pathway: The Kidney Health Check for Adults Living with Diabetes or Hypertension – How to identify Chronic Kidney Disease early!
- LKN CKD Optimisation Pathway – for adults with Type 2 diabetes and CKD (eGFR 25-75ml/minute/1.73m²)
- LKN CKD Optimisation Pathway – for adults with CKD and albuminuria (uACR ≥22.6mg/mmol and eGFR 25-
75ml/minute/1.73m²)
- LKN CKD Early Identification Pathway: The Kidney Health Check for Adults Living with Diabetes or Hypertension – How to identify Chronic Kidney Disease early!
Guidance documents
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- Download – Guidelines on CKD Coding in Primary Care: London Kidney Network Expert Consensus
- Download – Interpreting uACR & eGFR results: For clinicians
Other CKD Prevention Resources
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- Please download our Primary Care Resources Package and our Helpful Patient Information Package