Rising prevalence of chronic kidney disease in Ireland

New research has revealed that one-in-seven people over 50 have chronic kidney disease (CKD) in Ireland, and 98 per cent do not know they have the condition. The data was released from the largest study to date in Ireland that aims to characterise the population affected by CKD over the age of 50 years.

Trinity researchers analysed data from The Irish Longitudinal Study on Ageing in Ireland (TILDA), a nationally representative cohort study, and conducted the research in collaboration with the HSE. The findings have renewed calls for CKD to be included in the Chronic Disease Management Programme.

Commenting on the findings, Principal Investigator of TILDA Prof Rose-Anne Kenny noted that Ireland is “the fastest ageing country in Europe”, and that early diagnosis of CKD improves management of the disease and patient outcomes. “The data will assist new screening, referral, and management pathways for CKD, and increase independent living and quality-of-life for Irish adults,” she said.

Major findings from the study show:

– CKD prevalence in adults aged 50 years and over in Ireland is rising;

– CKD was present in 15.6 per cent of people aged over 50 in Ireland, which equates to approximately 226,000 people;

– 98 per cent of people who had CKD were unaware they suffered from it;

– Whereas blood pressure management should be tightly controlled in CKD to prevent or slow down progression, blood pressure was poorly controlled in CKD sufferers in Ireland;

– New cases of CKD in Ireland in people over 50 are occurring at a rate of 16 people per 1,000 person-years of follow up, which will likely also contribute to substantial future demand on nephrology services and hospital inpatient stay;

– Hypertension was the most common CKD-related condition in the Irish adult population. The estimated prevalence of CKD in Irish adults aged 50+ years without diabetes and hypertension was 6.22 per cent based on Wave 1 data, and 10.01 per cent based on Wave 3 of TILDA. Age, HbA1c, body mass index, and hypertension were significantly correlated with the presence and severity of CKD.

The increasing prevalence of CKD has implications for future treatment policies in nephrology, including healthcare resource allocation planning as part of Sláintecare, as well as the implications of new treatment options for CKD on the Chronic Disease Management Programmes in Ireland.

Prof Donal Sexton Lead author of TILDA and Consultant Nephrologist at St James’ Hospital described the report as “extremely important”, as it highlights “not only how common it [CKD] is but also emphasises the public health requirement to improve awareness and treatment in the light of new approved medications”.

He is among several experts calling for CKD to be incorporated into the Chronic Disease Management Programme in Ireland, to “facilitate improved treatment of the condition in primary care”.

Recommendations from the study include:

– Increased awareness of CKD and the adverse health outcomes associated with it are needed, including, cardiovascular disease, kidney failure, and premature death;

– The incorporation of CKD into the HSE Chronic Disease Management Programme for primary care may facilitate improved care of patients with CKD in Ireland;

– The introduction of medications known to reduce rates of deterioration in kidney function and reduce cardiovascular risk, such as SGLT2 inhibitors, GLP-1 analogues, and non-steroidal mineralocorticoid antagonists where appropriate;

– Improve blood pressure control in people with CKD in Ireland based on international guideline targets and aim to manage their additional cardiovascular risk factors.

Prof Colm Henry, Chief Clinical Officer in the HSE, said: “CKD is one of the most common comorbidities amongst the conditions already covered by the Chronic Disease Management Programme. In the advent of new disease-modifying medications, screening for CKD in high-risk groups is of paramount importance, in particular in primary care and opportunistic screening in secondary care. This work will help inform not just our renal service, but also chronic disease and renal transplant programmes.”

Prof George Mellotte, National Clinical Director for Renal Services and Carol Moore, CEO of the Irish Kidney Association, both said the results of the survey should reinforce calls for CKD to be integrated into the HSE National Chronic Disease Management Programme as a crucial step forward in managing the disease, improving patient outcomes, and decreasing healthcare costs.