It’s time to take action on kidney health inequalities, report urges

A new report from Kidney Research UK shows that inequalities in kidney health, due to age, gender, education, location or lack of wealth, persist, despite widespread awareness of the barriers some people face.

The UK’s leading kidney research charity is calling on the research community to take urgent action to tackle the social and economic inequalities that put some people at greater risk of kidney disease and can prevent patients from accessing appropriate care and treatment.

The new report“Time for action: a new review of kidney health inequalities” was written by an academic, clinical and patient team including Professor Fergus Caskey and Dr Mohammed Al-Talib from the University of Bristol.

It comes five years after the charity’s previous report on kidney health inequalities outlined 27 recommendations for change in clinical and research practice. The new review highlights the limited progress made since 2018, which is impacting people’s health and risk of disease.

The updated evidence confirms that some communities continue to suffer more from kidney disease than others, and that the disease is progressing more quickly in some people. The report concludes that the quality of care can vary and that a lack of focus on certain groups of people in research studies means that their needs and experiences are overlooked.

Often, inequalities overlap, with many people experiencing inequalities in multiple ways, increasing their risk of poor kidney health. The report shows how easily this can happen, with people of Black, Asian and mixed ethnicity being more likely to have kidney failure and need dialysis or a transplant to stay alive than white people.

Black people are more likely to live in deprived areas and kidney failure is twice as likely in people under 70 living in deprived areas. In addition, many people struggle with their mental health as a result of their kidney disease and it can have a cyclical effect, people with mental health problems are at greater risk of kidney disease progression and poorer outcomes.

The charity has identified key research gaps, including opportunities to use knowledge about genetic and social risk factors to design interventions to improve kidney health, to provide more evidence on how differentiated public health communications can help patients understand their diagnosis and care, and to demonstrate how optimising digital innovations in healthcare can reduce inequalities in kidney health.

The charity says meaningful involvement of patients with diverse personal demographics and life experiences should form the basis of all research.

Liz Lightstone, Professor of Renal Medicine at Imperial College London and Trustee of Kidney Research UK, said: “Kidney Research UK will continue to work tirelessly for patients by making targeted research investments. Wherever possible, we will seek to fund research that addresses these issues, starting with the grant round we open at the end of this month.

“Eliminating unjust inequalities in kidney health is an urgent priority and must become everyone’s responsibility so that we can build engagement and trust and drive real change. We look forward to working with other funders, organisations, healthcare decision-makers and the new government so that together we can ensure that everyone has a fair chance at good kidney health.”

Fergus Caskey, professor of renal medicine at the University of Bristol and one of the lead authors of the report, added: “More than 10% of the UK population has chronic kidney disease. That’s 7.25 million people. And we’re not all affected equally.

“Five years ago, Dr Gavin Dreyer from Barts Health NHS Trust and I led a study into kidney health inequalities in the UK, highlighting a higher risk of kidney disease development and progression in some groups of people. In particular, people from a South Asian or Black background are three to five times more likely to develop kidney failure and require dialysis than people from a White background.

“The review, commissioned by Kidney Research UK, made 27 recommendations that we hoped would lead to more equitable kidney health and outcomes. Now, five years later, with two new co-leads—Shivani Sharma and Bnar Talabani—we are assessing the progress made.

“The COVID-19 pandemic has created new inequalities and highlighted existing ones, but it has also changed the way the health and care sector works in ways that were unthinkable five years ago.

“This review takes stock of these lessons and changes and updates recommendations for everyone in the community to work on as part of their daily work. By raising awareness of these inequalities and making small changes to the way we work, we can all have an equal chance at kidney health.”

The report was compiled by UK kidney health experts and the kidney community, including kidney patients and primary and secondary care professionals.