Best Use of Thought Leadership
Commissioned by Boehringer Ingelheim, CF produced a landmark analysis revealing that chronic kidney disease costs the NHS £8.2 billion annually, contributes to 19,000 cardiovascular deaths, and leaves two-in-five advanced cases undiagnosed, with deprivation driving stark inequalities in diagnosis and treatment. The Case for Change has informed the Modern Service Framework for cardiovascular disease, been adopted by NHS England’s cardiovascular prevention programme, and will be presented at the World Health Assembly, catalysing action for over seven million people living with CKD in England.
Commissioned by Boehringer Ingelheim and conducted with Health Innovation Manchester and senior NHS clinicians, CF produced a landmark analysis of chronic kidney disease (CKD) in England, quantifying for the first time the full scale of its cardiovascular burden and making the case for earlier diagnosis and treatment. This was not a conventional research project but a policy-grade evidence base designed to shift national priorities, inform commissioning decisions, and ultimately save lives.
CKD affects over seven million people in England, contributes to approximately 19,000 cardiovascular deaths annually, and costs the NHS £8.2 billion each year. Yet two-in-five people with advanced CKD remain undiagnosed, and those in the most deprived areas wait three times longer for diagnosis and are six times more likely to need dialysis. Despite its scale, CKD attracts none of the Quality and Outcomes Framework indicators assigned to cardiovascular disease or diabetes, a structural gap between epidemiological significance and system priority that our work set out to close.
The cornerstone of our methodology was a dual-level analytical approach combining national datasets with a linked primary and secondary care cohort of 209,328 CKD patients in Greater Manchester. At the national level, we integrated Hospital Episode Statistics, CVDPrevent audit data, and National Cost Collection reference costs to quantify CKD’s cardiovascular burden across England. At the regional level, we tracked individual diagnostic pathways, deprivation gradients, prescribing patterns, and per-patient costs at a granularity that aggregate data cannot achieve, revealing a three-year diagnostic delay in the most deprived communities compared to one year in the least deprived, and SGLT2 inhibitor prescribing rates below 1% among CKD patients without diabetes, despite NICE recommendations.
Our findings showed that per-patient NHS costs rise from £352 annually at stage one to £21,794 at stage five. Scenario modelling, drawing on evidence from major randomised controlled trials, estimated that systematic earlier identification and treatment could prevent over 6,000 cardiovascular deaths, free over 300,000 hospital bed-days, and deliver net NHS savings of £500 million annually. In Greater Manchester alone, the analysis projected 250 lives saved and 2,100 cardiovascular events prevented each year.
The research highlighted a critical and overlooked dynamic: CKD, cardiovascular disease, and type 2 diabetes share the same upstream drivers, the same high-risk populations, and increasingly the same preventative solutions. Addressing cardiovascular prevention without explicitly incorporating CKD would leave a significant proportion of avoidable deaths unaddressed.
The Case for Change has gained substantial national traction. It has informed the Modern Service Framework for cardiovascular disease, setting targets for expected impact across England, been adopted by NHS England’s cardiovascular prevention programme, and referenced in Parliamentary briefings on health inequalities. The National Clinical Director for CKD will present findings at the World Health Assembly and NHS Confederation Expo. The BMJ has indicated interest in publishing, with a manuscript in development. In Greater Manchester, the analysis has directly catalysed the Circulation Health project, identifying 18,000 eligible patients not receiving guideline-aligned care and enabling up to 64,800 neighbourhood-led clinical interactions across 20 Primary Care Networks.
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