ASSIST-CKD – identifying and monitoring people at greatest risk of progressive chronic kidney disease.
We are leading a UK-wide project, supported by the Health Foundation, which involves over 20 renal units and pathology laboratories, and their surrounding GP practices covering an estimated population of around 11-12 million people across the UK. The project is known as ASSIST-CKD.
Our aim is to provide better and safer patient care by identifying people with chronic kidney disease (CKD) who are at the greatest risk of disease progression. We want to ensure they are referred to secondary care at the right time, for the right treatment in the right care setting, to potentially reduce the rate of decline and so delay or even avoid the need for dialysis or a kidney transplant.
"If the ASSIST-CKD project can prevent even a small number of people from developing kidney failure then it will be worth every penny spent and every man hour worked on it." Rob Finnigan, Member of Patient Project Team
Nearly 2 million people in the UK have been diagnosed with moderate-severe CKD by their GP but it is estimated that a further one million people remain undiagnosed as people with CKD often have little or no symptoms until the later stages of the disease. Patients also have an increased risk of cardiovascular disease and acute kidney injury (AKI).
The project is based on a system that has been running successfully at the Heart of England Foundation Trust (HEFT) in Birmingham. It uses software to map data from routine blood tests (eGFR), creating graphs of kidney function over time. For patients with deteriorating kidney function, the participating sites send a report, including the graph, to the referring GP with a prompt that specialist advice may be needed. Another benefit is that patients with more stable CKD can be discharged back into primary care confident that their kidney function will continue to be monitored via these graphs.
Since HEFT started the surveillance programme, they have one of the lowest late referral rates for dialysis in the UK. This is important as late referral to specialist care as kidney function declines, makes it much more difficult to prepare for dialysis or a kidney transplant and the outcomes for patients are not as good. Ideally patients need to be seen at least three months before they might need renal replacement treatment.
Benefits reported so far with the hospitals involved with ASSIST-CKD include prompting GPs to re-look at patient notes, review medications and refer to renal teams if their progressive kidney disease over time has not been identified previously.
Although the full results won’t be available until 2020, we are pleased how many of the hospitals are still running the system despite their funding only lasting for 12 months. We have had in depth discussions and interviews with a selection of the hospitals and GP practices which shows the impact so far:
- improved awareness of kidney disease in primary care
- understanding of GPs as to the importance of eGFR progression over time
- improved management of medicines that affect kidney function and
- involvement of patients in understanding their condition (where patients have been shown the graph).
"There is a UK-wide focus on improving the management of CKD and this project has enormous potential to provide better and safer care in a cost-effective manner. ASSIST-CKD is a collaboration between patients, kidney doctors and nurses, laboratory scientists and the primary care team which should benefit both patients and clinicians. We hope to demonstrate that the programme can be effective in other areas outside of the West Midlands, which should create a powerful case for universal adoption of the service across the UK.” Dr Hugh Gallagher, Project Lead for ASSIST-CKD
Reviewed September 2019.