CKD spells cardiac, kidney and diabetes as well as Chronic Kidney Disease. The Secretary of State launched this report on vascular checks or more precisely in the jargon – vascular checks: risk assessment and management – on Tuesday 1 April. The target audience includes General Practitioners, Primary Care Trusts and Strategic Health Authorities. There is an explicit call for stakeholders to work with the Department of Health and NHS to develop an effective implementation and delivery strategy. The announcement outlines proposals for a system of vascular checks to be carried out in primary care. The document includes initial results of modelling work around a “predict and prevent” approach to identify vulnerability to vascular disease – heart disease, stroke, diabetes and kidney disease.
The multiplication effect of risk factors and/or the presence of disease itself is emphasised. The link between kidney disease and other vascular diseases is highlighted.
The vascular risk assessment is based on the modifiable risk factors – smoking, physical inactivity and a sedentary lifestyle, hypertension, raised cholesterol levels and obesity.
The programme is designed for everyone between the ages of 40 and 74 in the population; that is individualised risk assessment for 3M people a year, with additional funding of £250M per year (from 2009/10), been allocated to implement the programme.
It will be based on straightforward questions and measurements. These will record basic information such as height, weight, current medication, age, family history, smoking and blood pressure and include assessment for cholesterol and, in some cases, glucose levels. Those who have been identified as at risk of kidney disease may then have further blood and urine tests. It is estimated that the programme will enable earlier detection of at least 25000 additional people per year with diabetes or kidney disease. This is over and above the large numbers now being picked up opportunistically through the inclusion of a chronic kidney disease domain in the Quality and Outcomes Framework.
This announcement comes hot on the heels of the publication of the handbook for vascular risk (or the blue book) that contains examples of best practice and tools to implement vascular and kidney risk reduction strategies in the community.
What next? A real opportunity for the kidney care community to get involved in shaping this programme which offers the prize of early detection and risk reduction of both vascular and progressive kidney disease in people at risk of or with kidney disease.