Presentation (CTI)

OBJECTIVES: Chronic kidney disease (CKD) is a silent, high-cost condition with strong links to cardiovascular morbidity and avoidable hospitalisation. Despite robust evidence for early intervention, most patients are not diagnosed until late-stage disease. This study quantifies the cost and clinical consequences of delayed CKD diagnosis in England and models the potential value of earlier identification and treatment, focusing on the use of SGLT2 inhibitors.
METHODS: We conducted a retrospective real-world analysis using national-level NHS data, including Hospital Episode Statistics (HES), prescribing datasets, and demographic projections. CKD-related healthcare resource use and costs were estimated across stages 2-5, with stratification by diagnosis status. We modelled a scenario in which patients with undiagnosed CKD are identified earlier and treated per NICE guidelines. Impact was assessed across four domains: hospital admissions, dialysis uptake, cardiovascular events, and total cost of care.
RESULTS: •Over 40% of CKD patients remain undiagnosed until late stages, contributing disproportionately to hospitalisation and dialysis costs. •Annual NHS spending on CKD and associated CVD exceeds £8 billion, with late-stage interventions accounting for over 60%. •Earlier identification and treatment of eligible patients with SGLT2 inhibitors could reduce progression to dialysis, prevent cardiovascular events, and save an estimated £45.7 million per year, offsetting the £23 million treatment cost. •Nearly half of projected savings stem from avoided hospital admissions and delayed renal replacement therapy.
CONCLUSIONS: Delayed CKD diagnosis leads to high-cost, low-value care. Real-world evidence shows that targeted early intervention using existing therapies could generate substantial cost savings and clinical benefit. Scaling earlier detection and treatment requires embedding CKD into population health strategies and rebalancing investment toward proactive care.