What are the barriers to effective CKD diagnosis and care? How can we overcome them?

10 October 2024

In a recent review article published in BMC Medicine, Dr Stuart Stewart from The Donal O’Donoghue Renal Research Centre has identified barriers and enablers to diagnosis of chronic kidney disease (CKD) in GP surgeries.

We caught up with Stuart about his research...

Thanks for taking the time to talk to us! Please can you tell us a bit about your role, and the path that led you to it?

“When I started as a GP, I was seeing so many patients with undiagnosed CKD. This surprised me because testing is simple and cheap to carry out, and we know diagnosis is important. I began thinking about the reasons for this, questioning our strategy for managing kidney disease in the UK and wondered how we might improve it.

As a GP and researcher, I wanted to do a PhD. Investigating the reasons for undiagnosed CKD was an obvious choice for me, because as a GP I know that getting this right is such an important first step in making sure everyone gets the best possible care for kidney disease.”

Dr Stuart Stewart

Meet the researcher

Stuart is a GP working in Manchester with an interest in the diagnosis and treatment of CKD. He applied to Kidney Research UK for a fellowship in 2023 to understand the impact of Covid-19 on kidney patient care in the UK.

Stuart's research

You’ve now completed the first year of your fellowship with Kidney Research UK. Please can you tell us a bit about why research in this area is so important and what you hope to achieve?

“We know CKD is a huge problem across the UK. It is particularly important because the high number of undiagnosed cases or late diagnoses lead to poor health outcomes for many patients and huge economic costs for the country.

I am undertaking three different pieces of work as part of my Kidney Research UK Fellowship, all of which aims to improve CKD detection, diagnosis and management in primary care.

Firstly, I am looking at changes in CKD care over time, with particular focus on two different time points that are critical from a GP’s perspective: the removal of financially incentivised CKD care from the Quality and Outcomes Framework (QOF) and the Covid-19 pandemic.

The second part explores missed cases of CKD, taking multiple health conditions into consideration to understand why this happens. Lastly, using themes from the Health Inequalities report, I am evaluating the performance of a risk prediction tool used to measure an individual’s risk of kidney disease progression across different patient groups depending on factors such as their socioeconomic background, sex and age.”

The Quality and Outcomes Framework

The Quality and Outcomes Framework (QOF), a pay for performance model in primary care, is a voluntary annual reward and incentive programme for all GP practices in England, detailing practice achievement results. It is not about performance management but resourcing and rewarding good practice. In 2015, many of the CKD indicators were removed from this framework, which has impacted how many patients are tested for and diagnosed with CKD.

Congratulations on your recent publication! Please can you talk us through what you did and the key findings?

“This paper analyses published research evidence on barriers and enablers to CKD diagnosis in GP surgeries in the UK. This work formed an important part of my application for funding Kidney Research UK.

The evidence collected shows that there are multiple barriers and enablers to diagnosis that have changed over time, and there have been lots of different strategies to try to improve CKD care. It is important to note that things do change in medicine and the NHS, so what has worked before may not necessarily work now or in the future.”

Some of the identified barriers to effective CKD care from Stuart’s review include:

Concerns regarding overdiagnosis

Complicated guidelines for doctors

The challenge of managing CKD in alongside other diseases (such as heart disease and diabetes)

Disruption to routine CKD care during and after the Covid-19 pandemic.

Key enablers of effective CKD care include:

Financially incentivised care

Electronic health record tools

Medical education

Policy changes

Looking more closely at the barriers you have identified, what does this mean for patients and their doctors?

“This paper is a useful starting point for future research and implementing changes. Sharing this information with patients will allow them to understand the complex barriers to CKD care at GP practices. This may also provide the chance to work with CKD patients on future interventions, to ensure they are effective for those living with CKD now and in the future.

Finding new ways to support GPs to prioritise CKD management is crucial and we also need to look at how best to manage CKD alongside diabetes and cardiovascular disease.”

And for our last question, what are the next steps for your project?

“The next step is to finalise analysis for measuring the impact of coding a diagnosis of CKD on health outcomes for different stages of CKD. And then from there, starting the analysis looking at the impact of the COVID-19 pandemic on CKD care.”