Outcomes for those with CKD
Most people with CKD never progress to kidney failure. Instead, the main clinical burden of CKD is a substantially increased risk of cardiovascular events compared with people without CKD.
This risk rises with the severity of kidney disease, measured in two ways:
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- Excretory kidney function (eGFR): the lower the eGFR, the higher the risk.
- Albuminuria: measured in clinical practice by albumin-to-creatinine ratio (ACR). The higher the ACR, the higher the risk.
CKD is often referred to as ‘silent’. This is incorrect. Although CKD lacks the clear set of symptoms seen in some other long-term conditions, people with CKD carry a substantial symptom burden, including severe fatigue, pain, breathlessness and high rates of psychological health problems. These symptoms worsen as CKD progresses.
Kidney disease and the Cardiovascular Modern Service Framework
There is increasing recognition that chronic kidney disease, heart disease, diabetes and obesity are closely linked, and that within the NHS we should be adopting more integrated approaches to care, including cardiovascular-kidney-metabolic (CVKM) models where appropriate, rather than treating each condition separately. For many people with CKD, particularly those living with cardiovascular and metabolic comorbidity, this is a significant shift: kidney disease is now recognised as a major cardiovascular risk factor, not something to be managed in isolation. At the same time, CKD encompasses a diverse range of conditions, and care must remain tailored to the underlying kidney disease and individual patient needs.
The Cardiovascular Disease Modern Service Framework (2026) puts earlier detection and prevention at its centre, including eGFR and urine ACR testing to find people with CKD sooner. As many people with CKD also live with conditions such as diabetes, hypertension and heart disease, they can expect a more holistic approach to their care rather than each condition being managed separately. This includes a greater focus on treatments that reduce both kidney and cardiovascular risk, in particular wider use of SGLT2 inhibitors, alongside optimal blood pressure control, lipid-lowering therapy and good diabetes care.
Delivering this depends on integrated care across traditional service boundaries, with coordinated working between primary care, neighbourhood health services, kidney teams and other specialties to provide more joined-up care for patients.
– Prof Smeeta Sinha, National Clinical Director Renal Medicine at NHS England