An Ipsos Mori survey commissioned by NHS England’s Think Kidneys programme in 2014 suggests that half the UK population were not aware that their kidneys make urine, while very few people knew that kidneys help in the processing of medicines. Over two-thirds believed that too much alcohol directly caused damage to the kidneys.
In response, the Think Kidneys programme has launched a public campaign to raise awareness of what the kidneys do and how to protect kidney health.
Kidney disease is part of a family of conditions that come under the umbrella of cardiovascular disease. These conditions are linked by common risk factors and a direct effect that they have on cardiovascular disease mortality and morbidity.
They include coronary heart disease, stroke, hypertension, hypercholesterolemia (a condition with excess of cholesterol in the bloodstream), diabetes, chronic kidney disease, peripheral arterial disease and vascular dementia.
Since its inception, we've been working with national partners and system leaders to improve health outcomes and quality of care for cardiovascular disease. Part of this has included working with colleagues across the renal community to identify public health opportunities for prevention and early diagnosis of kidney disease.
What is the problem?
Chronic kidney disease (CKD) is a common long-term kidney problem where the kidneys don't work as well as normal. It can worsen over time in some people, but treatment can often stop or delay this progression.
Many people may have CKD but not be aware of it. A simple blood test can be used to establish how well the kidneys are working, and the result is called a GFR (or glomerular filtration rate), the value of which is roughly the same as the percentage of a normal kidney function.
A low GFR was shown by the Global Burden of Disease study to contribute significantly to the overall population Disability Affected Life Years (DALYs) in England.
This low GFR indicator was grouped closely in the Global Burden of Disease study with other cardiovascular risks such as tobacco smoke, high systolic blood pressure and high fasting plasma glucose (a known risk factor for diabetes).
For those working in public health, the prevention and early detection of CKD represents a great opportunity to improve future health and well-being through reducing the burden of cardiovascular disease.
Who is at risk?
CKD frequently occurs alongside, or is caused or worsened by, other long-term conditions such as diabetes mellitus and hypertension. It becomes more common with increasing age, and it is estimated that one in five men and one in four women between the ages of 65 and 74 has some degree of CKD.
CKD is more common in people of black and south Asian origin, although NICE guidance is clear that age and ethnicity should only flag CKD risk if a person has other risk factors such as high blood pressure.
How can CKD be prevented?
The main way to reduce the chances of developing CKD is to carefully manage any existing conditions such as diabetes and high blood pressure, which we know are risk factors for developing CKD and other cardiovascular diseases.
Existing public health initiatives such as the diabetes prevention programme and the NHS Health Check also aim to reduce the number of people at risk of developing CKD in the future through lifestyle changes and medical management of risk factors.
How can it be detected?
CKD does not usually cause symptoms until it reaches an advanced stage, and is much better detected at earlier stages by blood and urine tests.
NICE guidance in 2014 recommended that some groups of people with existing conditions be checked for CKD because of their increased risk, along with patients taking drugs that can damage kidney function. Existing conditions associated with CKD are:
- acute kidney injury
- cardiovascular disease (ischaemic heart disease, chronic heart failure, peripheral vascular disease or cerebral vascular disease)
- structural renal tract disease, recurrent renal calculi or prostatic hypertrophy
- multisystem diseases with potential kidney involvement – for example, systemic lupus erythematosus
- family history of end-stage kidney disease (GFR category G5) or hereditary kidney disease
- opportunistic detection of haematuria
For people aged 40 – 74 without known medical problems the NHS Health Check is a key way to detect kidney disease in England. Recent data shows that the programme supports early detection with one person identified with CKD for every 265 checks.
What can individuals do?
NICE guidance advises that people with CKD take exercise, achieve a healthy weight and stop smoking. This could be beneficial for those at risk of CKD too, along with sensible advice from their care providers when taking medicines that could potentially damage the kidneys.
Much of PHE’s work, including public campaigns such as Change4Life and One You, aims to encourage healthy eating, drinking at low levels of risk and regular exercise – all of which can help to reduce the risk of CKD.
What can professionals do?
Think Kidneys’ summer campaign includes a series of posters and an infographic that professionals can download and display to help raise awareness of what the kidneys do and when they may be at risk.
PHE’s National Cardiovascular Intelligence Network (NCVIN) produces a range of tools for local authorities, health professionals and commissioners to help them plan services to treat and prevent kidney disease. NCVIN also works closely with NHS Right Care to produce CVD focus packs that present analysis of a wide range of CVD indicators and include a section on kidney disease. They focus on spend, activity, quality and outcomes.
We also support local authorities to increase uptake of the NHS Health Check, which can detect potential preventable problems including heart disease, stroke, type 2 diabetes and kidney disease.