Tackling the burden of chronic kidney disease

Dr Alexander Gueret-Wardle

Medical Affairs Manager, AstraZeneca UK

Dr Kate Bramham

London-based Nephrologist

*Edited by AstraZeneca

 People living with underlying health conditions and those from minority ethnic groups face an increased risk from chronic kidney disease.

Chronic kidney disease (CKD) is a long-term condition where the kidneys do not work effectively. It can pose a silent risk to people with underlying cardiovascular conditions, from ethnic minorities and lower socioeconomic backgrounds.^1,2,3

Yet there are hopes that education, awareness, and a more proactive role among health professionals, can help drive earlier diagnosis, address inequalities and reduce the need for kidney dialysis or transplantation. 

Health inequalities

London-based kidney specialist Dr Kate Bramham remains concerned about the level of health inequalities around CKD and that certain groups are “being left behind” in the fight against the condition. “I am concerned about ethnic minority groups, particularly people of Black ethnicity. They tend to present later with kidney problems, are younger and have more complications.” 

Current services, she adds, are not good enough yet to deliver early diagnosis and prevention strategies, and risk factors such as diabetes, hypertension, smoking and obesity are not being acted upon soon enough for lower socio-economic groups, and ethnic minorities, who are up to five times more likely to develop CKD than other groups.²

I am concerned about ethnic minority groups, particularly people of Black ethnicity. They tend to present later with kidney problems, are younger and have more complications.

Silent disease

 CKD can be a ‘silent disease’, with people not having symptoms until kidney disease is more advanced.⁴

But Dr Bramham believes screening those with high blood pressure, diabetes, and a family history of kidney disease, is crucial via testing urine for protein, which is a recognised marker of kidney damage, to slow risk of progression to kidney failure.⁵

Technology can play a role too. One project she pointed to uses smartphone technology to analyse home urine dip tests and transmit the results directly to GPs. 

Dr Bramham says this is an “exciting time” in terms of new opportunities to delay progression of CKD, but she adds: “It is absolutely critical that we think carefully about delivery of care, to ensure that those with more risk factors, in harder-to-reach groups are not left behind.” 

Cardiovascular link

Dr Alex Gueret-Wardle, who is AstraZeneca UK’s CKD Lead, says the strong cardiovascular link to CKD is a fundamental, yet under-recognised concern.

 In the UK, an estimated 3 million people have CKD, but as many as 1 million people may be undiagnosed.^1,6

“While not everyone progresses with CKD to a point where they need supportive therapies, like dialysis,” he says, “CKD is strongly associated with an acceleration of cardiovascular disease which is responsible for significant morbidity and mortality in people living with CKD.”

He stresses the importance of greater awareness but believes primary care physicians can be more active in urine test screening for at-risk groups.

CKD is strongly associated with an acceleration of cardiovascular disease which is responsible for significant morbidity and mortality in people living with CKD.

Raising awareness

Dr Gueret-Wardle pointed to data showing the sizable burden of CKD with over 100,000 unplanned hospital admissions in England and Wales⁷ and an estimated 45,000 premature deaths a year.⁶

While progress is being made to improve outcomes for CKD, its prevalence in the UK is growing.⁸ Generating greater awareness of the risk factors for CKD, may contribute to reducing inequalities around the disease and ensuring early diagnosis and intervention, so people with CKD can live well for longer.

June 2021. GB-29253