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June 9, 2015

Primary health care should play a bigger role in managing chronic kidney disease

Healthy eating, regular exercise and blood pressure and cholesterol control are among the most effective ways of managing the early stages of chronic kidney disease (CKD).

These are the findings of a review undertaken by researchers from the London School of Economics and Political Science, Salford Royal NHS Foundation Trust and US National Institutes of Health, published today in Nature Reviews Nephrology.

The article analysed which interventions are most effective for CKD in the early stages. It also explored what the optimum time is to provide clinical care for patients with early-stage CKD and what model of care is most suitable for these patients.

CKD, which involves the gradual loss of kidney function, is one of the most common conditions in the world and a major cause of kidney failure. CKD affects more than 10 per cent of the adult population in many high-income countries, and it is estimated that more than $1 trillion is spent worldwide on kidney failure treatment.

The article finds that primary care interventions should play a more prominent role in the treatment and management of patients in the early stages of CKD than it currently does. The review shows that:

  • Most CKD patients suffer from related conditions, such as Type 2 diabetes and high blood pressure, which are usually the underlying causes of their kidney disease; CKD can worsen if these related diseases are left uncontrolled.
  • CKD care should focus more on preventing the deterioration of health in those with related conditions than on costly specialist care.
  • Preventive measures—cholesterol and blood pressure control, smoking cessation, healthy eating habits and regular exercise—can produce notable benefits on cardiovascular and kidney health outcomes.
  • There are substantial shortcomings in the way CKD patients are currently being treated and managed in primary care, notably suboptimal prescribing and management for those patients who also have hypertension and Type 2 diabetes.

“Better preventive care for patients with early CKD can go a long way toward protecting kidney health and lowering spending on costly treatment,” said lead author Olivier J. Wouters, a doctoral candidate and research associate at the London School of Economics and Political Science. “These findings should serve as a reminder of the important role that primary care physicians play in public health.”

In the article, the authors note that the available evidence is of mixed quality, and that the development of CKD registries would further our knowledge about the effectiveness of various treatment strategies. Registries—databases which contain information on the health status, health-care use, and health-care costs of patients with a particular condition—should be set up to facilitate economic analyses. Such analyses can help to inform future models of care.

Editor’s notes
The paper “Early chronic kidney disease: diagnosis, management, and models of care” is available online in Nature Reviews Nephrology. It was authored by Olivier J. Wouters from the London School of Economics; Professor Donal J. O’Donoghue and Dr James Ritchie from Salford Royal NHS Foundation Trust; Professor Panos G. Kanavos from LSE Health; and Dr Andrew S. Narva from the National Institutes of Health (NIH). Professor O’Donoghue served as the first national director for kidney care (2007-2013) in the U.K. Department of Health.

For more information, please contact Olivier J. Wouters o.j.wouters@lse.ac.uk or +27 619 700 487 or Professor Donal J. O’Donoghue donal.o’donoghue@srft.nhs.uk or +44 7801 834 202

For a copy of the article, please visit: www.nature.com/nrneph/journal/vaop/ncurrent/pdf/nrneph.2015.85.pdf