Skip to main content
Article thumbnail
Location of Repository

The cost of implementing UK guidelines for the management of chronic kidney disease

By Bernhard Klebe, Jean Irving, Paul E. Stevens, Donal J. O'Donoghue, Simon de Lusignan, Roger Cooley, Helen Hobbs, Edmund J. Lamb, Ian John, Rachel Middleton, John New and Chris Farmer


Background. Chronic kidney disease (CKD) is a major public health problem. In the UK, guidelines have been developed to facilitate case identification and management. Our aim was to estimate the annualized cost of implementation of the guidelines on newly identified CKD cases.\ud Methods. We interrogated the New Opportunities for Early Renal Intervention by Computerised Assessment (NEOERICA) database using a Java program created to recompile the CKD guidelines into rule-based decision trees. This categorized all patients with a serum creatinine recorded over a 1-year period into those requiring more tests or referral. A 12-month cost analysis for following the guidelines was performed.\ud \ud Results. In the first year, a practice of 10 000 would identify 147.5 patients with stages 3-5 CKD over and above those already known. All stages 4-5 CKD cases would require nephrology referral. Of those with stage 3 CKD (143.85), 126.27 stable patients would require more tests. The following would require referral: 14.8 with estimated glomerular filtration rate decline >= 5 ml/min/ 1.73m(2)/year, 1.11 with haemoglobin < 11 g/dl and 1.67 with blood pressure > 150/90 on three anti-hypertensives. The projected cost per practice of investigating stable stage 3 CKD was is an element of 6111; and is an element of 7836 for nephrology referral. Total costs of is an element of 17 133 in the first year were increased to is an element of 29 790 through the effect of creatinine calibration.\ud \ud Conclusions. CKD guideline implementation results in significant increases in nephrology referral and additional investigation. These costs could be recouped by delaying dialysis requirement by 1 year in one individual per 10 000 patients managed according to guideline

Topics: R1, RC
Publisher: Oxford University Press
Year: 2007
OAI identifier:

Suggested articles


  1. (1999). A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. doi
  2. (2003). A populationbased study of the incidence and outcomes of diagnosed chronic kidney disease. doi
  3. (2006). Audit based education to reduce suboptimal management of cholesterol in primary care: a before and after doi
  4. (2004). Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. doi
  5. (2006). Chronic Kidney Disease in Adults. UK Guidelines for Identification, Management and Referral. doi
  6. (2004). Comparative analysis of lower urinary tract symptoms and bother in both sexes. Urology doi
  7. (2006). Continued late referral of patients with chronic kidney disease. Causes, consequences, and approaches to improvement. Presse Med
  8. (2004). Costs doi
  9. (2006). Health. The National Service Framework for Renal Services. Part I and Part II. PolicyAndGuidance/HealthAndSocialCareTopics/Renal/fs/en. Accessed on
  10. (2005). Identifying patients with chronic kidney disease from general practice computer records. Fam Pract doi
  11. (2002). K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. doi
  12. (1996). Late diagnosis of chronic renal failure and mortality on maintenance dialysis. Nephrol Dial Transplant doi
  13. (2002). Late referral for end-stage renal disease: a region-wide survey in the south west of England. Nephrol Dial Transplant doi
  14. (1984). Late referral for maintenance dialysis. doi
  15. (1993). Late referral to maintenance dialysis: detrimental consequences. Nephrol Dial Transplant
  16. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med 2004; 164: 659–663 Received for publication: 12.10.06 Accepted in revised form: doi
  17. (2005). management and referral of adults with chronic kidney disease: concise guidelines. Clin Med doi
  18. (2007). Management of chronic kidney disease in the United Kingdom: results from the NEOERICA project. Kidney Int. advance online publication 18 doi
  19. (2005). Men in Australia Telephone Survey (MATeS): a national survey of the reproductive health and concerns of middle-aged and older Australian men. Lancet doi
  20. (2003). Prevalence of chronic kidney disease and decreased kidney function in the adult US population: third National Health and Nutrition Examination Survey. doi
  21. (2003). Prevalence of chronic kidney disease in an urban Mexican population. Kidney Int 2005; 97 [Suppl]: S11–S17 The cost of implementing UK guidelines for the management of CKD doi
  22. (2003). Prevalence of kidney damage in Australian adults: the AusDiab kidney study. doi
  23. (2004). Prevalence of lower urinary tract symptoms in men aged 45–79 years: a population-based study of 40 000 Swedish men. doi
  24. (2004). Prevalence of lower urinary tract symptoms in men aged 45–79 years: a population-based study of 40000 Swedish men. doi
  25. (2003). Prevalence of three lower urinary tract symptoms in men-a population-based study. Fam Pract doi
  26. (2004). Revised European best practice guidelines for the management of anaemia in patients with chronic renal failure. Nephrol Dial Transplant
  27. (2006). Screening strategies for chronic kidney disease in the general population: follow-up of cross sectional health survey. BMJ doi
  28. (2003). Should all patients with stage 4-5 CKD be referred to Renal Services?
  29. (2002). Specialist evaluation in chronic kidney disease: too little, too late. Ann Intern Med doi
  30. (1007). The British Medical Association. Revisions to the new GMS Contract 2006/2007. revisionnGMSFeb20062. Accessed on
  31. The National Service Framework for Renal Services. Part 1. Dialysis and Transplantation.
  32. (2003). The nephrologist’s role in the management of calcium-phosphorus metabolism in patients with chronic kidney disease. Kidney Int doi
  33. (1999). The pattern of referral of patients with end-stage renal disease to the nephrologist–a European survey. Nephrol Dial Transplant doi
  34. (2006). The Renal Association. Documents and Reports. http:// tract2006.pdf. Accessed on
  35. (2005). The validity of searching routinely collected general practice computer data to identify patients with chronic kidney disease (CKD): a manual review of 500 medical records. Nephrol Dial Transplant doi
  36. (2005). Trends in the prevalence and management of diagnosed type 2 diabetes 1994-2001 in England and Wales. BMC Family Practice
  37. (2004). Unreferred chronic kidney disease: a longitudinal study. doi

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.