Kidney Disease

This topic area covers statistics and information relating to chronic kidney disease in Hull including local strategic need and service provision.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page).

Headlines

• Chronic kidney disease is a long-term condition with no cure, although in most cases can be controlled effectively with medicine and regular check-ups, but 1 in 50 patients go on to develop kidney failure and CKD can increases the risk of developing cardiovascular disease.
• For 2023/24, there were 8,200 patients aged 18+ years in Hull who were registered with Hull GPs who had been diagnosed with chronic kidney disease representing 3.3% of the patient population aged 18+ years. This is considerably lower than other areas within the Humber and North Yorkshire Integrated Care Board and lower than England (4.4%).
• The prevalence across the GP practices in Hull has decreased over time from 4.3% in 2012/13 to 3.1% for 2020/21, although has increased slightly in the last three years to 3.3% in 2023/24. In contrast, the prevalence for England remained relatively unchanged between 2014/15 and 2021/22 at 4% and has increased in the last two years to 4.4% for 2023/24.
• For 2023/24, there was a strong association with age with regard to the prevalence of CKD across the 28 GP practices in Hull with a prevalence of 1.4% for practices serving the youngest fifth of patients compared to 4.1% for practices serving the oldest fifth of patients in Hull.
• The numbers of new patients added to the renal replacement therapy register has increased substantially in Hull from 86 per million patients in 2007-12 to 118 per million patients in 2015-20 with a slight decrease to 113 per million patients for 2016-21. This equates to around five patients per year for the most recent six year period, so the numbers are small.
• The total number of patient receiving renal replacement therapy in 2021 in Hull was 273 which equates to around 114 patients per 100,000 population which is similar to England (117). Renal replacement therapy includes dialysis and blood filtration as well as kidney transplant which is the ultimate renal replacement therapy.
• Patients in Hull were the least likely across the Integrated Care Board to receive dialysis at home with only one in twenty doing so in 2020 (8.0% for England). Patients were also among the least likely (range 50% to 62%) to have a kidney transplant across the Integrated Care Board at 55% although the rate was similar in Hull to England (56%). The percentage of patients receiving a kidney transplant as part of their renal replacement therapy has been relatively constant in Hull at 55% between 2014 and 2020, whereas the rate has increased slightly across England from 52% to 56% over the same period. The percentage of patients receiving dialysis at home has decreased in Hull between 2014 and 2020 whereas the percentage receiving dialysis in hospital has increased.

The Population Affected – Why Is It Important?

Chronic kidney disease (CKD) is a long-term condition where the kidneys do not work effectively, which does not usually cause symptoms until it reaches an advanced stage. It may only be diagnosed if you have a blood or urine test for another reason and the results show a possible problem with your kidneys. Symptoms in more severe disease include tiredness, swollen ankles, feet or hands, shortness of breath, nausea and blood in the urine.

Chronic kidney disease is usually caused by other conditions that put a strain on the kidneys. Often it is the result of a combination of different problems. CKD can be caused by high blood pressure (hypertension), diabetes, high cholesterol, kidney infections, glomerulonephritis (kidney inflammation), polycystic kidney disease (an inherited condition where growths – cysts – develop in the kidneys), blockages in the flow of urine (for example, kidney stones or an enlarged prostate), long-term use of certain medicines such as lithium and non-steroidal anti-flammatory drugs.

Age and ethnicity are the other main risk factors for CKD.

Most people with CKD will be able to control their condition with medicine and regular check-ups. CKD only progresses to kidney failure in around 1 in 50 people with the condition. People with CKD – even mild CKD – are more at risk of developing other serious problems such as cardiovascular disease.

Different stages of severity of kidney disease have been defined on the basis of how quickly the kidneys are cleaning the blood and is reported in millilitres per minute (mL/min). Normal glomerular filtration rate (GFR) is 90mL/min or more. The original stages were defined by the US National Kidney Foundation Kidney Disease Outcomes Quality Initiative in 2002. Patients with stage 1 had kidney damage with normal or high GFR of 90mL/min or more, patients with stage 2 CKD had kidney damage and a mild decrease in GFR of 60-89mL/min, patients with stage 3 CKD had a moderate decrease in GFR of 30-59mL/min, patients with stage 4 CKD had a severe decrease in GFR of 15-29mL/min, and patients with stage 5 CKD had established renal failure with a GFR of less than 15mL/min or are on dialysis. An updated guideline in 2008 suggested sub-dividing stage 3 into 3a (GFR 45-59mL/min/1.73m²) and 3b (GFR 30-44 mL/min/1.73m²). An updated guideline also recommends classifying CKD using a combination of GFR and albumin creatinine ratio (ACR).

CKD is one of the diseases that is recorded within the Quality Outcomes Framework so practices are paid to produce a register of patients who have CKD. For 2015/16, these registers used stages G3a-G5 to classify a patient as having CKD, but for previous years the register used stages 3-5. This is a technicality as both are reporting on patients whose GFR is less than 30mL/min.

Renal replacement therapy (RRT) is the therapy that replaces the normal blood filtering function of the kidneys when the kidneys are not working well and kidney failure has occurred generally for acute or chronic kidney disease at stages 4 and 5. RRT includes a number of methods of dialysis and ways to filter the blood with or without machines. The ultimate RRT is kidney transplantation so kidney transplant is also included within RRT.

The Hull Picture

Prevalence

The Office for Health Improvement & Disparities’ Fingertips gives the percentage of patients registered with Hull GPs who are diagnosed with chronic kidney disease (CKD). The sub Integrated Care Board areas which include Hull are within the Humber and North Yorkshire Integrated Care Board. In Fingertips, the sub-ICB area referenced by 03F relates to Hull (see Integrated Care Board for the codes relating to the other local sub-ICB areas).

For 2023/24, the prevalence of CKD among patients registered with Hull GPs at 3.3% which is considerably lower than all other areas within the Humber and North Yorkshire Integrated Care Board and lower than England (4.2%).

There were 8,200 patients aged 18+ years who were diagnosed with CKD among Hull patients in 2023/24. Whilst the prevalence of CKD across the Integrated Care Board and England has remained relatively constant over time or with a slight increase in the last two years, the prevalence in Hull has decreased from 4.3% in 2012/13 to a low of 3.1% in 2020/21, although the percentage in Hull did increase to 3.3% for the last three years.

From the local analysis of the national Quality and Outcomes Framework datasets, there was a statistically significant association between average age of the practice patients and the prevalence of diagnosed CKD across the 28 practices in Hull for 2023/24. If the practices were divided into five approximately equal sized groups based on average age of patients (with each fifth having approximately one-fifth of the total registered patients in Hull) then the prevalence increased from 1.4% for the practices serving the youngest practice patients to 4.1% for the practices serving the oldest practice patients. For every increase in the average age of the patients of 10 years, the prevalence of CKD increased by 2.1 percentage points. Further analysis of diagnosed disease by the average age of practice patients is within the file above and within Local Analysis of Quality and Outcomes Framework Data.

There was no statistically significant association between the prevalence of diagnosed CHD and the average deprivation score of registered patients (using the Index of Multiple Deprivation 2019) across the 28 practices.

Renal Replacement Therapy

Fingertips also presents information on the number of people accepted onto renal replacement therapy (RRT). The number of people accepted onto the RRT can vary due to population differences, clinical need, treatment thresholds and acceptance policies.

The crude rate is presented as the number of people accepted onto RRT (from the UK Renal Registry database) within a specific period of time divided by the total population of the area. The rates are presented as the number per million population.

Over the six year period 2016-21, the rate of people accepted onto RRT for Hull (03F) was the highest across the Integrated Care Board area and slightly higher than England.

With 113 per million population for Hull over six years, this equates to a very small number of patients of around 30 in total or around five per year.

The rate of patients in Hull accepted onto RRT per million population were substantially lower than England for 2007-12, but have increased at a faster rate compared so that the rate for 2015-20 was marginally higher than England, although the rate decreased slightly in 2016-21 in Hull with no such change nationally so that the rate in Hull is marginally lower than England for 2016-21.

In 2021, there were 273 patients of Hull GPs who were aged 18+ years who received kidney replacement therapy.

As the total number of people rather than the rates are given, it is not possible to compare across the different geographical areas without considering the total population aged 18+ years. The number of patients aged 18+ year registered with GPs in the respective sub-ICB (from Quality and Outcomes Framework dataset 2022/23) together with the number and rate per 100,000 population aged 18+ years receiving RRT is given in the table below.

Code	Area	Patients aged 18+ years	Receiving RRT N	Receiving RRT rate per 100,000 population
ENG	England	49,277,553	57,560	117
02Y	East Riding of Yorkshire	253,831	313	123
03F	Hull	242,077	275	114
03H	North East Lincolnshire	136,635	148	108
03K	North Lincolnshire	147,838	167	113
03Q	Vale of York	304,955	333	109
42D	North Yorkshire	359,136	421	117

Since 2012, the total number of people receiving RRT has increased in Hull from 196 to 273 people aged 18+ years which represents a 39% increase. Over the same period of time, the increase for England has been 29%.

In 2021 patients in Hull (03F) are as likely as in England as a whole to have a kidney transplant as part of their RRT, whilst the levels are lower than the regional average.

If there are around 273 patients on RRT treatment in Hull during 2021, then this would equate to around 14 patients receiving dialysis at home, 108 patients receiving dialysis in hospital and 150 receiving a kidney transplant.

In 2014, the percentage of Hull patients receiving dialysis at home was 7.7% and at a similar level to England, but since then the percentage has decreased in Hull before increasing in the last three years. The percentage in England has remained relatively unchanged.

The percentage of patients receiving their dialysis in hospital increased from around one-third of patients in 2013 to around four in ten patients in 2017, and the percentage has remained around 40% between 2017 and 2020. In contrast, the percentage of patients across England receiving dialysis in hospital has been reducing gradually over time from 40% in 2013 to 36% in 2021.

The percentage of patients receiving a kidney transplant as part of RRT has remained around 55% in Hull between 2014 and 2021 whereas the rate in England has increased. Between 2013 and 2016, the percentage in England was consistently lower than Hull, but since 2016 this has no longer been the case.

Strategic Need and Service Provision

Whilst a minority of people with high blood pressure suffer symptoms such as persistent headache, blurred vision or double vision, nosebleeds or shortness of breath, most people with high blood pressure have no symptoms. As high blood pressure is a strong risk factor for CKD, it is therefore important that people have their blood pressure measured at least once every five years.

People aged 40-79 years who are eligible for the NHS Health Check should be encouraged to attend. People already diagnosed with diabetes, high blood pressure or CKD should attend their annual reviews so that they get the best on-going treatment for their condition, and other medical conditions such as CKD are picked up quickly.

Resources

NHS. Chronic kidney disease: overview. https://www.nhs.uk/conditions/kidney-disease/

Kidney Research UK, Stages of kidney disease.  www.kidneyresearchuk.org. 2015, Kidney Research UK: London.

National Institute for Health and Care Excellence, Clinical guideline 73: Chronic kidney disease: early identification and management of chronic kidney disease in adults in primary and secondary care, 2008.  www.nice.org.uk. 2008, National Institute for Health and Care Excellence: London.

National Institute for Health and Care Excellence, Chronic kidney disease: assessment and management, 2021.  www.nice.org.uk. 2021, National Institute for Health and Care Excellence: London.

The Office for Health Improvement & Disparities’ Fingertips: https://fingertips.phe.org.uk/

NHS Digital. Quality and Outcomes Framework. https://qof.digital.nhs.uk/

Updates

This page was last updated / checked on 8 October 2024.

This page is due to be updated / checked in January 2025.