The University of Southampton
Medicine

Improving care for patients with chronic kidney disease

Observational research led by the University of Southampton has made an important contribution to understanding the determinants and outcomes of chronic kidney disease (CKD) and evidenced the effectiveness and accessibility of dialysis for end-stage kidney failure in the UK. Our work has influenced haemodialysis services, informed national policy, and ultimately contributed to better patient outcomes.

Overview

Research Challenge

CKD is a major global health problem costing an estimated £1.46 billion in England alone. With a particularly high occurrence in older people the disease has adverse effects on cardiovascular risk and other morbidities including acute kidney injury. CKD also has the potential to progress to end-stage renal failure which may require costly renal replacement therapy such as dialysis or transplantation.

Context

 Southampton led observational epidemiological and health services research aimed to provide a better understanding of the frequency, determinants and outcomes of CKD and RRT, and to improve the provision of care for patients.

Our solution

Academics began by analysing data from the first National Renal Review which showed that dialysis rates in patients declined with distance from renal units. Subsequent evaluation of new peripheral renal satellite units showed them to be as cost effective, and more accessible, than main renal units.

A following population-based local study was the first in the UK to show that people diagnosed with CKD were more likely to die of cardiovascular disease (CVD) than progress to needing dialysis, highlighting the need to focus on CVD risk reduction.

Further analysis of an over 75 cohort showed that CKD markers were independent predictors of mortality, morbidity, poorer quality of life and lower cognitive function.

What was the impact?

Southampton led research has influenced both dialysis service provision and the detection and management of CKD.

Over 50,000 patients now receive RRT treatment in the UK, a substantial increase on the previous two decades. 50% of total patients, and most older patients, have hospital haemodialysis in local satellite units, reducing patient transport and cost.

CKD is now recognised as part of the family of vascular disorders and its detection is part of the NHS Vascular Checks Programme. Increased detection in primary care and improved management have led to falls in late CKD referral rates from 27% to 19% resulting in improved outcomes for patients.

patient undergoing dialysis
patient undergoing dialysis

Media

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Key Publications

Research Staff

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