Chronic kidney disease (CKD) is a common,
harmful, but treatable long term condition. Some
three million people in the UK suffer from CKD.
The single largest cause is diabetes niellitus—but other
risk factors include hypertension and being of black and
minority ethnic (BME) origin—a hugely disproportionate
2% of the NHS budget is spent on treatment for kidney
disease. Kidney Research UK, a national charity dedicated
to research that will lead to better treatment and cures for
kidney disease, has developed the A Better Life through
Education and empowerment (ABLE) programme which
seeks to research and raise awareness of the issues among
'at risk' groups. This second article in the series provides a
general overview about CKD and specifically focuses on a
form of renal replacement treatment, continuous ambulatory
peritoneal dialysis (CAPD).
Background
CKD is often progressive. It may involve damage or abnormality
in both kidneys, signs of which may manifest in one
or more of a number of blood, urine and other tests. It may
involve a loss of kidney function, with or without other
evidence of kidney damage. CKD is often asymptomatic
until renal function is severely reduced. For the majority
of people with CKD, the main risk is cardiovascular disease
(CVD). The cardiovascular changes often begin early in
the history ofthe disease. However, an important minority
of people will go on to develop established renal failure
(ERF), which is fatal without treatment by dialysis or a
kidney transplant (Department of Health (DH), 2005).
CKD is often under-recognized, particularly in primary
care, and can therefore lead to late referrals to specialist
care from Nephrologists. With such a delay, there are lost
opportunities for effectively managing the condition and
avoiding further and possible irreversible deterioration in
kidney function. This is therefore likely to have a severe
impact on the patients quality of life, requiring treatment
that may otherwise not have been necessary. When CKD
has progressed despite optimal treatment, timely referral to
a nephrologist allows patients to be adequately prepared for
dialysis and significantly reduces the risk of hospital admission
and mortality (Rayner et al, 2003).
The need for collaborative working and good liaison
between primary and secondary care is illustrated well in
the area of CKD and its interaction with diabetes,