Pilot programme for patients with Chronic Kidney Disease will be expanded following its success

A pilot programme for people living with Chronic Kidney Disease in Leicester, Leicestershire and Rutland (LLR) is helping to revolutionise patient care and could be rolled out elsewhere. 

It follows the findings of an independent report into the LLR Chronic Kidney Disease Integrated Care Delivery Programme (LUCID) which outlined the pilot’s success and has been developed as part of a Joint Working initiative between The John Walls Renal Unit, UHL and AstraZeneca UK.

The LUCID approach brings together GPs, kidney consultants, clinical pharmacists, social prescribers, data staff and specialists in a multidisciplinary team, enabling a thorough discussion about each patient's care plan to ensure that it is considers all aspects of their health to reduce the risk of heart attacks and strokes, delay progression to dialysis and prevent hospital visits. 

Chronic Kidney Disease (CKD) is a long-term condition where gradual loss of kidney function over time causes the kidneys to become less effective at filtering waste products from the blood.  In the UK it is estimated that around 7.2 million people are living with CKD stages 1-5^1. Kidney disease costs the UK economy £7 billion a year and could rise to £13.9 billion in just ten years. 

Dr Rupert Major, Associate Professor at University of Leicester and Honorary Consultant Nephrologist at University Hospital of Leicester NHS Trust who co-developed LUCID, said: "Kidney disease is a public health emergency and LUCID, a collaboration between University Hospitals of Leicester and Leicester, Leicestershire and Rutland Integrated Care System, has shown its clinical impact to deliver more integrated care for people living with kidney disease. 

“Earlier detection and intervention for kidney disease is crucial to reduce the risk of both the need for dialysis or a kidney transplant and also heart attacks and strokes, which are more common if you have kidney disease. Both have profound impacts on quality and quantity of life so we’re delighted this independent report has shown the benefit of the LUCID approach and look forward to sharing it across the region and nationally.”

The evaluation of the pilot, which began in April 2022, saw trials take place in 54 clinics, across nine Primary Care Networks (PCN), covering large parts of LLR. 

LUCID brings consultant expertise into primary care through increased education, a tool to identify high risk patients, and LUCID clinics to support patient management where primary care clinicians, including pharmacists and nurses have been upskilled by consultants.

The evaluation report funded by Health Innovation East Midlands and produced by healthcare analytics firm, Edge Health, says that LUCID has: 

• Led to better clinical outcomes with patients receiving faster referrals and earlier intervention to slow down disease progression

• Greater patient satisfaction and increased confidence in their care

• Wider uptake of the NICE recommended Kidney Failure Risk Equation (KFRE), a validated risk prediction tool for kidney replacement therapy (dialysis or kidney transplantation) in individuals with CKD 

• Increased patient awareness on how to manage their condition, leading to improved engagement with their treatment and better quality of life

• Estimated cost benefits of £1,200 per LUCID clinic, rising to estimated cost benefits of just under £3 million annually if the LUCID model is scaled across the entire East Midlands in the medium to long term

Not only is the pilot scheme set to be expanded more widely across the region but it could be extended to the care of patients with other long-term conditions.

Michael Ellis, Senior Innovation Lead at Health Innovation East Midlands, said: “The evaluation has shown that better integration between primary and secondary care for this condition positively impacts patient outcomes.”

Professor Michael Steiner, Deputy Chief Medical Officer for NHS Leicester, Leicestershire and Rutland Integrated Care Board (ICB), said: "Importantly, the programme offers improvement in the quality of care that can be delivered to patients in their own communities through innovative collaboration between primary care and specialist teams.”

Dr Ed Piper, Medical and Scientific Affairs Director for AstraZeneca UK, said: “AstraZeneca has a powerful mission to reduce CKD disease progression by 50% by working in partnership with healthcare systems. I’m excited by the results from LUCID which demonstrate a compelling, cost-effective model to deliver improved care for people with CKD in Leicester and the surrounding areas.  This is a notable example of how partnerships between the NHS and industry can result in improved patient experience and I’m hopeful that the strength of the data will support adoption of LUCID in other regions of UK."

Dr Aisling McMahon, Executive director of research at Kidney Research UK, believes it is “imperative” new ways to improve earlier detection and prevention are found to “avoid the considerable burden of dialysis.”

Fiona Loud, Policy Director of Kidney Care UK, called the LUCID programme “novel and exciting.”

She added: “It shows that by making simple changes we can help to identify people at risk, ensure they receive the right tests and are offered interventions to help delay decline in kidney health.”  

LUCID has been shortlisted in two categories in the prestigious national Health Service Journal Awards (HSJ) which recognise outstanding contributions to healthcare. The categories are: Integrated Care Initiative of the Year and Medicines, Pharmacy and Prescribing Initiative of the Year. 

*A copy of the evaluation report is available on request

References

1. Kidney Care UK website, Key facts about kidneys, accessed 21st August 2024, https://kidneycareuk.org/kidney-disease-information/about-kidney-health/facts-about-kidneys/