title: Early chronic kidney disease: diagnosis, management and models of care.
abstract: Chronic kidney disease (CKD) is prevalent in many countries, and the costs associated with the care of patients with end-stage renal disease (ESRD) are estimated to exceed US$1 trillion globally. The clinical and economic rationale for the design of timely and appropriate health system responses to limit the progression of CKD to ESRD is clear. Clinical care might improve if early-stage CKD with risk of progression to ESRD is differentiated from early-stage CKD that is unlikely to advance. The diagnostic tests that are currently used for CKD exhibit key limitations; therefore, additional research is required to increase awareness of the risk factors for CKD progression. Systems modelling can be used to evaluate the impact of different care models on CKD outcomes and costs. The US Indian Health Service has demonstrated that an integrated, system-wide approach can produce notable benefits on cardiovascular and renal health outcomes. Economic and clinical improvements might, therefore, be possible if CKD is reconceptualized as a part of primary care. This Review discusses which early CKD interventions are appropriate, the optimum time to provide clinical care, and the most suitable model of care to adopt.
authors.affiliation: LSE Health, Cowdray House, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK.
authors.forename: Olivier J
authors.initials: OJ
authors.lastname: Wouters
authors.affiliation: Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK.
authors.forename: Donal J
authors.initials: DJ
authors.lastname: O'Donoghue
authors.affiliation: Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK.
authors.forename: James
authors.initials: J
authors.lastname: Ritchie
authors.affiliation: LSE Health, Cowdray House, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK.
authors.forename: Panos G
authors.initials: PG
authors.lastname: Kanavos
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, 31 Center Drive, Bethesda, MD 20892-2560, USA.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Narva
mesh_terms: D018450:Disease Progression; D006801:Humans; D007676:Kidney Failure, Chronic / Q000517:prevention & control; D008962:Models, Theoretical; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000628:therapy*