The number of patients receiving long term renal replacement therapy in the United Kingdom is growing inexorably and treatment already consumes more than 2% of the total NHS budget. The cost of managing patients who present late in the course of progressive chronic kidney disease, the evidence that progression can be slowed or halted, and evidence that chronic kidney disease is associated with increased risk of cardiovascular disease have focused attention on how to optimise the management of early disease in primary care. Policies and guidelines have been designed to improve the recognition, management, and referral of patients with chronic kidney disease by non-specialists. However, the routine laboratory estimation of glomerular filtration rate (GFR) using the simplified modification of diet in renal disease (MDRD) equation has proved controversial.1 Here we describe the UK policies on identifying and managing chronic kidney disease and address some of the concerns about estimating GFR.