What is it about?

This article considers the practicalities and cost-effectiveness of screening for chronic kidney disease among at-risk groups and the general population. The systems currently in place to deliver screening for both groups use flawed methodology to determine the presence of chronic kidney disease, while failing to meet screening target numbers. The cost-effectiveness of such systems is therefore compromised. Meanwhile, despite the rising incidence of chronic kidney disease, patients in known at-risk groups, including those with common conditions such as diabetes or hypertension, have no guarantee of being screened. This raises major questions about how the NHS can practically and cost-effectively tackle the rising prevalence of chronic kidney disease. A major revision of strategy is needed to address the human and financial costs associated with failure to identify and effectively manage chronic kidney disease.

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Why is it important?

Although there are established systems that could enable screening for chronic kidney disease at population and at-risk group level, these systems are not fit for this purpose. Even when a diagnosis is formally made and recorded at primary care level, a significant number of individuals seem unaware of their changed health situation, its implications and possible consequences. There are existing practical and cost-effective ways to screen for kidney disease at both population and at-risk group level, but where is the will?

Perspectives

Screening is ESSENTIAL. The time has come to move to an integrated care AND clinical (medical) model and it is urgently needed to manage ALL OF US. Trying to manage a holistic being with a silo/compartmental structural and clinical approach has never been the way to deliver optimal, holistic and cost-effective healthcare and optimised wellbeing. Perhaps it is only when this happens, will kidney disease really be recognised as a disease that when prevented, (and once established, managed to minimise impact) will impact all body systems, and it will be realised that optimal management of kidneys is central to optimal health wellbeing. Crews et al (2019) argue that until all countries understand and establish critical minimum infrastructure to reduce the burden and consequences of kidney disease, there will be no progress towards the WHO aspiration of establishing universal health coverage worldwide by 2030 within their stated Sustainable Development Goals, with resultant equity of resources for kidney disease like that allocated to other long-term conditions. That acute kidney injury, chronic kidney disease, and end stage kidney disease are prioritised in only 13%, 51%, and 58% of 195 governments is unacceptable (BELLO et al, 2017), as is the extensive list of health topics on the WHO website, which makes no reference to the word kidney! https://www.who.int/health-topics Please try it!!!! Bello, A. et al K, (2017). Global Kidney Health Atlas: A report by the International Society of Nephrology on the current state of organization and structures for kidney care across the globe. International Society of Nephrology. https://www.theisn.org/wp-content/uploads/2021/05/GKDAtlas_2017_FinalVersion-1.pdf Accessed 12/06/2021 Crews, D. et al (2019) Burden, Access and Disparities in Kidney Disease: World Kidney Day editorial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437937/pdf/1414-431X- bjmbr-52-3-e8338.pdf Accessed 08/06/2021 PLEASE READ Global Burden of Disease: Chronic Kidney Disease Collaboration (2020) Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020; 395(10225):709–733. https://doi.org/10.1016/S0140-6736(20)30045-3 - http://www.healthdata.org/research- article/global-regional-and-national-burden-chronic-kidney-disease-1990–2017- systematic). Accessed 16/06/2021

Jane Bridger

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This page is a summary of: The practicalities and cost-effectiveness of screening at-risk groups for kidney disease, British Journal of Healthcare Management, September 2020, Mark Allen Group,
DOI: 10.12968/bjhc.2019.0073.
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