Management of chronic kidney disease (CKD) is a particular focus in East London, England, which has an ethnically diverse population with high levels of social deprivation and high rates of diabetes. The population has higher-than-average progression to end‐stage kidney disease, and higher rates of mortality and morbidity due to associated cardiovascular disease. My colleagues and I were determined to develop novel approaches to reducing the burden of dialysis in this, our, local community, and supporting patients to self-manage is an important part of doing so.
The How to Look After Your Kidneys Program
The East London Community Kidney Service, started in 2016, is a collaboration between primary and secondary care practitioners that aims to systemize CKD identification and improve management within primary care while providing rapid access to renal specialists for appropriate patients. As part of this service, the kidney nurse‐led education service How to Look After Your Kidneys was developed to provide education for people with CKD stage 1–3b who were referred to our virtual CKD clinic but did not require a nephrology outpatient appointment.
The patient education program combines fact-based teaching with motivational interviewing techniques. The information included in the program builds on type 2 diabetes and hypertension education programs and aims to promote self-management. Education sessions are delivered as one-off sessions, either in one-to-one consultations with a clinical nurse specialist in a hospital outpatient setting, or through group education sessions held in general practice offices. In an evaluation, published in Journal of Renal Care, we report results from patient surveys (n=54) and interviews (n=9) that aimed to understand the experiences of people with stage 1–3b CKD who had attended an education session during the second year of the service (January-December 2017). A secondary aim was to assess the usefulness of the education resources to primary care nurses (n=21).
CKD Information can Motivate Change Primary care practitioners in the UK are contracted to undertake annual reviews with patients who have type 2 diabetes or hypertension, including screening for CKD. We found that patients were not always well-informed about their kidney problems, so opportunities to implement changes that could improve health were potentially missed. Our education session increased self-reported knowledge (Figure), with two-thirds of survey respondents reporting making changes to improve their health after the session, most commonly to change diet or increase fluid intake.
However, understanding the implications of a CKD diagnosis is just the start, and patients require ongoing support to understand their CKD test results and the impact of any changes. This support is sometimes lacking, as evidenced by a participant who said, “When I go for the blood test and I go for the result, [the nurse] would only say there’s a bit of a problem with the kidney and that’s it.”
Nurses are ideally placed to provide this support as part of long‐term conditions monitoring. Although we received very few responses to our nurse survey, 50% (10/20) had attended an education session run by the kidney team and had changed their practice following this. As one nurse wrote, “I now include self‐management of chronic kidney disease in part of diabetes and hypertension reviews.”
Supporting Colleagues in Reducing CKD Burden
Healthcare practitioners may be concerned that making a diagnosis of CKD will cause patients unnecessary anxiety without benefit, but early diagnosis disclosed in a meaningful way can promote health behavior change. Renal services need to upskill primary care practitioners to feel confident to incorporate kidney messages in annual diabetes and hypertension reviews. Staff education sessions are part of this, but innovative solutions are also needed to ensure that resources are available at the point of care. We plan to work with primary care nurses to develop group consultations based on our program. We hope that by working alongside our primary care colleagues, we will see a reduction in the burden of disease experienced by patients with CKD and a slowing in progression to end-stage kidney disease.
Innovative education for people with chronic kidney disease: an evaluation study
Hull et al (2020). BMC Nephrology 21:10 doi.org/10.1186/s12882-020-1682-6
Thomas & Rainey (2018). J Kidney Care doi.org/10.12968/jokc.2018.3.2.114