QJM Advance Access originally published online on February 23, 2006
QJM 2006 99(4):245-251; doi:10.1093/qjmed/hcl029
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Current chronic kidney disease practice patterns in the UK: a national survey
From the 1UK Renal Registry, Southmead Hospital, Bristol,2Public Health Sciences and Medical Statistics, University of Southampton, Southampton General Hospital, Southampton,3Renal Unit, Freeman Hospital, Newcastle Upon Tyne,4Renal Unit, Nottingham City Hospital, Nottingham, and5Department of Renal Medicine, Salford Royal Hospital NHS Trust, Salford, UK
Address correspondence to Dr A. Ahmad, UK Renal Registry, Southmead Hospital, Southmead Road, Bristol, BS10 5NB. email: azhar.ahmad{at}btinternet.com
Received 8 October 2005 and in revised form 2 February 2006
Background: There is an increasing focus on improving the detection and management of patients with chronic kidney disease (CKD). Data on CKD prevalence based on population sampling are now available, but there are few data about CKD patients attending nephrology services or how such services are organized.
Aim: To survey services for CKD patients nationally.
Methods: A pre-piloted questionnaire was sent to all 72 renal units in the UK, referring to the situation in June 2004.
Results: Seventy units (97%) responded. The median ratio of prevalent CKD patients/prevalent renal replacement therapy (RRT) patients in the 25 units with data was 3.7 (IQR 2.7–5.7) and the median ratio of CKD stage 4 and 5 patients/prevalent RRT patients was 0.6 (IQR 0.4–1.1). This gives an estimated 140 000 CKD patients under the care of UK nephrologists, with 23 000 at CKD stage 4 or 5 (excluding those on RRT). Very few units had a full complement of the recommended multi-skilled renal team. Counsellors and psychologist were the most common perceived shortages. Of 70 responding units, 50 (74%) were using low clearance clinics for management of advanced CKD patients. Elective dialysis access services often had long delays, with median waiting time for vascular access ranging between 1 and 36 weeks, and for Tenchkoff catheter, between 0 and 12 weeks.
Discussion: CKD patients are a significant workload for UK nephrologists. Current provision of service is variable, and services need to be re-designed to cope with the expected future increase of referral of CKD patients.
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