CPD: Sustainable chronic kidney disease management

In the latest in our CPD series, nurse kidney specialist Gloria Munoz–Figueroa explains the principles of sustainable chronic kidney disease (CKD) care, including the importance of early diagnosis and enhanced risk-based management in primary care. Read the full module on Nursing in Practice 365 today.

Protecting kidney health has never been more urgent. Chronic kidney disease (CKD) affects over 850 million people worldwide and is projected to become the fifth leading cause of death by 2040.

In the UK alone, millions are living with CKD, placing a substantial and growing financial burden on the NHS – largely driven by the high cost of dialysis and kidney failure treatment.

At the same time, healthcare systems face increasing pressure from limited dialysis capacity and rising transplant waiting lists. Beyond clinical and economic challenges, kidney care also carries a considerable environmental footprint. These factors together highlight the critical need for a shift toward earlier detection, prevention, and more sustainable, patient-centred approaches.

This module will describe the principles behind the sustainable CKD model and the important role of nurses in primary care to ensure early identification and enhanced risk-based management to help delay CKD progression.

Related Article: Type 2 diabetes treatment updates: putting NICE into practice

Learning objectives

This module will inform your understanding of sustainable approaches to CKD care, including how to:

• Understand kidney health through a sustainable care lens, recognising how biological, social, environmental and commercial determinants influence chronic kidney disease (CKD) outcomes.
• Describe the global and UK epidemiology of CKD, including the implications of rising prevalence, health inequalities, dialysis capacity constraints and the carbon footprint of kidney care.
• Use appropriate screening and coding strategies in primary care, including KDIGO C-G-A classification and colour-coded risk visualisation, to support early identification and equitable care.
• Differentiate between CKD staging and risk prediction, understanding use of the Kidney Failure Risk Equation (KFRE) to better inform personalised care, referral timing and sustainable service planning.
• Integrate comprehensive lifestyle medicine interventions, addressing all pillars – nutrition, physical activity, substance use, stress, sleep and social connection – as core components of kidney and cardiometabolic risk reduction.
• Appreciate the sustainability and climate-resilience benefits of early intervention, including reduced dialysis dependence, lower emergency admissions and decreased carbon emissions associated with kidney care.

Protecting kidney health had never been more imperative. Over 850 million people globally are living with chronic kidney disease (CKD), a silent, non-communicable disease that is expected to be the fifth leading cause of mortality by 2040.¹

The most recent update of the Global Burden of CKD is alarming, highlighting that there is one death related to CKD every 20 seconds.²

In the UK, 7.2 million people are currently living with CKD, 3.25 million of whom have been diagnosed with CKD stage 3-5. Currently, CKD costs the NHS £6.4bn/year, yet many remain undiagnosed.³ The largest cost driver is kidney failure treatment. Dialysis costs about £34,000 per patient per year. Around 30,000 people in the UK receive dialysis, costing the NHS over £1bn annually.³

Significant capacity pressures at in-centre haemodialysis level and a growing transplant waiting list highlight the urgent need for preventive, patient-centred, and environmentally sustainable care models. A 2020 study by Dorset Renal Service estimated the carbon footprint of kidney care to be 18 times higher than for other medical specialties,⁴ mainly driven by dialysis, transport, water use and consumables.

Early CKD identification provides a window of opportunity to implement non-pharmaceutical and pharmaceutical interventions, preserve residual kidney function, slow CKD progression and reduce cardiovascular risk, as well as reduce the environmental impact of kidney care.

Assessing cardiovascular-kidney-metabolic (CKM) risk

Assessing CKM risk – recognising that cardiovascular, kidney and metabolic disease are all interconnected – rather than CKD in isolation helps us to target interventions to slow CKD progression and reduce cardiovascular events, thereby limiting the need of high-carbon footprint therapies.

It is also important to consider lifestyle, social, environmental, and commercial domains as part of screening, monitoring and care planning.

Related Article: Warnings issued over ibuprofen’s impact on kidneys

Clinicians can use this framework, outlined in table 1 below, to guide personalised, sustainable kidney care identifying patients who require more intensive intervention.

Table 1: CKM risk factors, kidney impact and assessment

Screening and early identification

CKD is silent until in the advanced stages and can affect anyone, making systematic screening for CKD essential. This is particularly important for individuals at high risk of kidney disease such as those with:

• Diabetes
• Hypertension
• Previous episode of Acute Kidney Injury.
• Cardiovascular disease.
• Structural renal tract disease, recurrent renal calculi or prostatic hypertrophy.
• Multisystem diseases, for example, systemic lupus erythematosus.
• Gout
• Family history of kidney disease.
• Incidental detection of haematuria or proteinuria.

According to NICE guidelines, CKD diagnosis requires measurement of the estimated glomerular filtration rate (eGFR) and proteinuria, as indicated by the albumin to creatinine ratio (ACR).⁵

NICE then advises classification of CKD by a combination of the eGFR category (1-5) and ACR category (A1-A3), in line with Kidney Disease Improving Global Outcomes (KDIGO) guidance.

Related Article: Practice dilemma: How can I support a patient refusing to take their hypertension medication?

Complete the full module worth 1.5 CPD hours on Nursing in Practice 365  

Gloria Munoz-Figueroa is a nurse kidney specialist and lead nurse for advanced kidney care at Imperial College Healthcare NHS Trust. She has expertise in running CKD community clinics, an MSc in Global Health and Social Justice from King’s College London and is current co-chair of the UK Kidney Association Sustainable Kidney Care Committee

References

1. Foreman K et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories. Lancet 2018;392(10159):2052-90
2. Ortiz A et al. The updated global burden of chronic kidney disease: one death every 20 seconds. Nephrology Dialysis Transplantation 2026; Early online publication.
3. Kidney Research UK. Kidney Disease: A UK Public Health Emergency. 2023
4. Sustainable Healthcare Coalition. Sustainable kidney care: The problem with renal replacement therapy.
5. NICE. Chronic kidney disease: assessment and management. [NG203] 2021