Activities of the Chronic Kidney Disease HIT in 2018-19

Dr Fergus Caskey gives an update on the work of the Chronic Kidney Disease Health Integration Team (CKD HIT) over the last year.

The kidneys filter toxins from the blood, balance salt and water and make a number of hormones essential for healthy bones and blood cells. More than one person in 10 has some evidence of chronic kidney disease (CKD), often in the context of other diseases like diabetes, heart disease, stroke, high blood pressure and obesity.

Sudden drops in kidney function, usually when people are very ill, are known as acute kidney injury (AKI) and identify people at high risk of mortality. When the kidneys fail permanently many of their roles can be replaced by dialysis or transplant, which offers the best chance of good quality of life. Some frail older people can’t have a transplant and some consider the demands of dialysis too onerous and instead choose palliative care. These are major treatment decisions for people and their families and they require thoughtful presentation of the best available information if the right decision is to be made by each individual.

The work of the CKD HIT focuses on a number of points on this pathway. In looking at safer prescribing in kidney disease, we have searched the literature for indicators of (un-)safe prescribing and plan to work with GPs to reach a consensus on safe prescribing in kidney disease. The aim is to produce a tool that can assess (un-)safe prescribing in routine healthcare datasets.

We are assessing the risk of AKI with certain blood pressure medication, using a large research-ready GP database to look at the risk of AKI in people starting renin angiotensin aldosterone system blockers. Although these drugs are protective for kidneys and hearts in the long term, there is a small risk of AKI.

We are educating community healthcare professionals on the care needs of people at the end of life with kidney failure. This builds on the Bristol-led Prepare for Kidney Care randomised control trial of preparing for dialysis vs preparing for responsive management.

With the national Kidney Quality Improvement Partnership, we are working to reduce delays in access to kidney transplant for people living in the South West. We also have several research projects underway. The ASK trial addresses socioeconomic inequity in living donor kidney transplant. We are also analysing UK Renal Registry data to explore inequalities in access to living kidney donor transplant in the UK Chinese population.