Primary and secondary care need to set up a model of combined care

Epidemiological studies have shown that renal disease is common. In the United States, the third national health and nutrition survey (Nhanes III) has shown that 4.3% of the population has chronic kidney disease with a glomerular filtration rate of 30-59 ml/min/1.73 m², and 0.2% has chronic kidney disease with a glomerular filtration rate of less than 15-29 ml/min/1.73 m².1 In the United Kingdom, screening for renal disease by retrospective surveys of plasma creatinine measurements from chemical pathology laboratories serving defined populations has shown a similar prevalence of more severe chronic kidney disease (0.2-0.5% general population).2 3 In both studies, patients were followed longitudinally; very few developed end stage renal disease, as the major cause of death was cardiovascular disease. So what model of care should we use to look after this large number of patients with varying degrees of chronic kidney disease?

Increasing numbers of studies have shown that the presence of …