#4167 THE HEALTH, SOCIOECONOMIC AND ENVIRONMENTAL IMPACT OF CKD IN THE UK: BUILDING A CONCEPTUAL FRAMEWORK
Authors: Bermudez Isaac Bencomo , Webber Charlotte Johnston , Sanchez Juan Jose Garcia , Wharton George , Duncan Neill , Fluck Richard , Javaid Yassir , Roderick Paul , Wheeler David C , Mcguire Alistair 
Published: June 2023

Abstract

Background and Aims
The past three decades have seen an increase in the prevalence and mortality rate of chronic kidney disease (CKD). It is estimated that between 1990 and 2017, the global all-age prevalence of CKD increased by 29.3%, whilst the mortality rate rose by 41.5%. Over this period, CKD became the 12th leading cause of death worldwide, with an estimated 1.2 million deaths attributed to the disease in 2017 [1]. With global prevalence currently estimated at 10% [2], CKD is a leading cause of disability, accounting for 35.8 million disability-adjusted life years (DALYs) in 2017 [3]. This growing burden of the disease calls for robust healthcare policy interventions to improve disparities in health, socioeconomic, and environmental outcomes. The aim of this research is to build a Healthcare Policy framework for CKD that will analyse the drivers and components of the burden of disease in terms of clinical, socioeconomic and environmental outcomes. It will also incorporate current knowledge of best practices and challenges in the organisation of healthcare services to mitigate these burdens. The framework will facilitate the analysis of the burden of disease attributable to CKD and be used to inform further research on areas in which policies could be implemented to optimise CKD prevention, early detection, and treatment at different stages of CKD and different levels of health systems. The framework presented here reflects the UK context but can be adapted for different country contexts.

Method
The framework development included two stages. First, a scoping review of the literature in this field was conducted. The literature review included peer-reviewed articles, grey literature, policy documents, academic reports and congress and conference reports. The second stage saw the validation of the framework by a multidisciplinary expert panel in the UK. This expert panel was composed of eight UK experts in the fields of nephrology, public health, primary care, organ donation and transplantation, and other disciplines.

Results
The framework outlines a holistic patient pathway from pre-CKD development to kidney failure along with the corresponding interdisciplinary level of care. The framework stresses the need to implement a population-wide approach focused on preventative care strategies, chiefly on the risk reduction of kidney failure. Underlying aetiologies and disparities in access to care were found to be inherently linked to disease progression and health outcomes. Data systems were identified as vital to ensuring continuity of care between primary and specialty care which in turn could lead to improved patient outcomes. The use of greener energies coupled with a reduction in the incidence of renal failure requiring dialysis could reduce substantially the environmental footprint of this disease. The burden of disease reflects the sum of the individual and system-level impact and outcomes of CKD which are labelled as economic, social, and environmental (Fig. 1).

Conclusion
The conceptual framework underscores how underlying aetiologies, socioeconomic factors, and fragmentation of care are reflected in disparities in healthcare access, particularly in marginalised and underserved populations. The environmental footprint of this disease could be reduced through optimal standard of care. The framework can inform future research to model the burden of CKD in terms of clinical, societal, economic, and environmental outcomes in the UK and the targeting of policy interventions to mitigate these burdens across different country contexts.