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Kidney disease is a public health emergency that threatens to overwhelm the NHS, major new report reveals

05 June 2023

Kidney disease has become a public health emergency in the UK, with cases of the health condition growing so rapidly it risks costing the UK economy £13.9billion annually by 2033 without significant government intervention, a major new report has found.

The front cover of the Health Economics report document

Kidney Research UK has today published the independently produced report into the economic impact of kidney disease alongside stark projections that could see NHS capacity for dialysis treatment overwhelmed unless the disease becomes a government priority. 

The report, Kidney disease: A UK public health emergency, lays bare the growing costs of kidney disease, both in treating patients and in money lost to the economy by people being left unable to work due to time-consuming and gruelling treatment.  

Written by health economics specialists, the report was created with insight and input from a group of 30 contributors including leading academics, clinicians from across the NHS and kidney patients.

Urgent action needed

  • Kidney disease is costing the UK economy £7 billion a year, costs which could rise to £13.9 billion in just ten years
  • Growing numbers of people are at risk of kidney disease due to increased cases of diabetes, heart disease, high blood pressure and obesity
  • Significant government action is needed to implement four healthcare interventions that could save 10,000 lives in the UK by 2033

Key findings in the report

The report found the current economic burden of kidney disease in the UK is £7 billion per year, with £6.4 billion being direct costs to the NHS, approximately 3.2% of total NHS spending across the four nations. 

By 2033, if projected figures for the number of dialysis patients are realised, those figures could rise to as much as £13.9 billion and £10.9 billion respectively.  

The report also found that £372 million is lost to the UK economy every year from missed work due to dialysis alone, a figure that could rise to £2 billion by 2033. 

The key driver to future costs is potential growth in demand for dialysis – an essential treatment for patients who have reached kidney failure. 

A total of 30,000 adults and children are currently on dialysis, taking existing NHS capacity to its limits. Using predictive modelling approaches, the report found that by 2033, the number of people in need of dialysis treatment could rise to as much as 143,000 – meaning existing capacity would need to grow by almost 400% to meet essential demand. 

There are estimated to be 7.2 million people in the UK currently living with chronic kidney disease, more than 10% of the entire population. Whilst 3.25 million of those are at the most severe stages, a further 3.9 million people are thought to be living with the early stages of kidney disease, which is frequently undiagnosed and shows no symptoms, but many of these people could progress to needing medical intervention.  By 2033 it is predicted the total number of people with chronic kidney disease will increase to 7.61 million. 

People with diabetes, high-blood pressure, cardiovascular disease and obesity are all at increased risk of developing kidney disease, with the numbers of people with these risk factors also growing. 

Sandra Currie, chief executive of Kidney Research UK said: “These figures are a stark warning, kidney disease has reached the point of being a public health emergency for the UK and unless serious action is taken the NHS risks being overwhelmed with demand.

“There is no cure for kidney disease, a transplant does not last a lifetime and dialysis patients face hours of gruelling treatment every week, taking them away from loved ones and making it harder to work. 

“We know the only hope for stopping the growth of kidney disease and the increasing burden to the health system, the economy and to patients is better prevention strategies, earlier diagnosis and better treatment options, and yet kidney disease isn’t even included in NHS long-term strategic plans.  

“The report provides some hope and offers some solutions, but only if there is a committed and active response. “ 

Sandra Currie, chief executive of Kidney Research UK

Healthcare interventions

Alongside the figures, the report also found that implementation of four healthcare interventions could save more than 10,000 lives between 2023 and 2033. 

All of the interventions were found to meet National Institute for Health and Care Excellence payment thresholds and combined, would be cost effective for the NHS, with one, increased rates of transplantation, being cost saving.

Kidney Research UK is now calling for chronic kidney disease to be made a priority in government and NHS long-term health plans, including the forthcoming Major Conditions Strategy and NHS Long-Term Plan Update for England and equivalent plans in Scotland, Wales and Northern Ireland.  

Despite the costs of treatment, in 2021/22 kidney disease received just 1.4% (£17.7million) of relevant government research funding and the charity is now calling for this to rise to at least £50 million a year and for prevention to be a clear priority.  It also wants to see more tests for people at risk of kidney disease so fewer reach kidney failure. 

Sandra Currie added: “This report provides clear evidence that the risks and burden of kidney disease are very real and cannot be ignored by governments any longer. This recognition of kidney disease as a priority health condition is long overdue. The projections highlight the very real risks to a health and care system already under significant strain and it is essential that the UK government and devolved administrations act now to ensure treatment will be available for those who need it and to invest in research into prevention.” 

Proposed healthcare interventions in more detail

  • Earlier and improved diagnosis, targeting under-served populations through outreach programmes to improve screening opportunities and increase early diagnosis
  • Improved management of chronic kidney disease for patients who are either untreated or not receiving standard care according to clinical guidelines (e.g. adequate blood pressure management)
  • Greater use of new medications such as SGLT-2 inhibitors – a medication used in diabetes treatment but which also slows progression of kidney disease
  • Increased rates of transplantation, specifically pre-emptive transplants that would prevent people needing dialysis. This intervention would be cost saving for the NHS.

Decisions made by the National Institute for Health and Clinical Excellence (NICE) about whether the NHS should fund treatments are based on a cost effectiveness model. NICE guides refer to a threshold of £20 000-£30 000 per quality adjusted life year (QALY) - a commonly used measure in health economic evaluations to quantify the effect of a medical intervention or prevention programme.

Call for government action

Kidney Research UK is asking people across the UK to join them in calling for government action on kidney disease, starting by writing to their MPs to ask them to attend a parliamentary event in September to hear more about the findings from the report.

Find out more

Full and summary versions of the report, together with interactive dashboards setting out the scale of kidney disease across the UK at country and regional levels are available to view.

How future projections are made

Modelling for potential demand for dialysis in 2033 used two approaches. 

  • The first – a ‘constrained’ view, looks at NHS capacity for dialysis and assumes it will continue to grow based on the actual number of patients treated over the last ten years.
  • The second – an ‘unconstrained’ view, focuses on the number of people who may need dialysis, based on future projections of the number of kidney disease patients and how quickly they progress through the stages of the disease.

If NHS capacity continues to grow at current rates – the constrained view – this would mean dialysis would be available to 33,845 patients in 2033.

The unconstrained view, based on projections for future demand, found that the number of patients needing dialysis in 2033 could be as high as 142,920, meaning capacity would need to grow by almost 400%, just to meet demand.

Even if this number was realised by half, the growth in demand would outstrip capacity.
The report warns that basing projections on historical data risked underestimating the true level of future need, particularly for dialysis and transplantation, necessitating the unconstrained view projections. 

Human kidney cross section

What are kidneys and what do they do?

The kidneys are complex organs that control blood chemistry, blood pressure and the amount of fluid in the body. Kidneys are as vital as our heart.

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