Kidney disease: cost and variation in care

A report, commissioned by NHS Kidney Care, says that chronic kidney disease causes up to 45,000 premature deaths each year – more than for lung and breast cancer combined – with a large proportion of these deaths being attributed to stroke, heart attack, bone disease and other conditions. The report, Chronic Kidney Disease in England: The Human and Financial Cost was undertaken to examine the impact of chronic kidney disease (CKD) and associated complications and comorbidities on the quality of life, mortality and its cost to the NHS in England. More than 1.8 million people in England have diagnosed CKD and it is believed that a further 1 million people have the condition but are undiagnosed. People with CKD will have a gradual loss of kidney function over time. While only a minority will suffer complete kidney failure and require renal replacement therapy (RRT) – dialysis or transplant – people with CKD are also at increased risk of stroke, heart attack, bone disease and other conditions and these risks increase as the disease progresses. People with CKD are at greater risk of death than people of the same age and sex with healthy kidneys. The risk increases as the disease progresses and is a far greater risk than that of progression to RRT.

The cost of CKD

The NHS in England spent an estimated £1.45 billion on CKD in 2009/10, equivalent to £1 in every £77 of NHS expenditure and amounting to more than is spent on breast, lung, colon and skin cancer combined. This estimate covers treatment directly associated with CKD as well as treatment for excess non-renal problems such as strokes, heart attacks and infections in people with CKD. In the case of non-renal problems, costs are estimated only for excess events, over and above the expected number for people of the same age and sex who do not have CKD. Figure 1 gives a breakdown of how the report identified distribution of NHS spending on CKD. There were an estimated 7,000 extra strokes and 12,000 extra myocardial infarctions (MIs) in people with CKD in 2009/2010, relative to the expected number in people of the same age and sex without CKD. The cost to the NHS of healthcare related to these strokes and MIs is estimated at between £174 m and £178 m. The report also identified that people with CKD have longer hospital stays than people of the same age without the condition, even when they go into hospital for treatments unrelated to CKD. The report goes on to estimate that the average length of stay for people with CKD is 35% longer, resulting in a cost to the NHS of these excess hospital bed days amounting to £46 m in 2009/10. More than half the total estimated expenditure on CKD is for RRT, although the RRT population comprises only one in 50 of the diagnosed CKD population. The mean annual cost of direct CKD care per patient receiving dialysis was roughly estimated to be £27,000, the cost per transplant recipient at £12,000 and the cost per patient not receiving RRT at £235. Infections such as MRSA are also more common in people with CKD, in particular in those receiving haemodialysis. The risk of MRSA is more than 100 times greater in people receiving haemodialysis than in the general population and the cost to the NHS of MRSA in haemodialysis patients is estimated to be £1.4 m.