Cardiovascular-kidney-metabolic (CKM) disease – where heart disease, kidney disease, diabetes, and obesity co-exist and exacerbate each other – is rising at an alarming rate in the UK. CKM conditions impose a major burden on the NHS and have a significant impact on the quality of life for people living with them.
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In the UK, chronic kidney disease affects 7.2 million people, diabetes 6 million people, and cardiovascular disease 7.2 million people, costing the NHS £6.4bn, £10bn, and £7.4bn respectively. Kidney disease alone is increasing so quickly that charity Kidney Research UK has declared it a “public emergency”, warning that costs could rise to £13.9bn in just eight years’ time if left unchecked1.
Despite this trend, there’s little mention of cardiovascular-kidney-metabolic conditions specifically in NHS long-term strategic planning, although we await full details of the 10-year plan in the spring.
Kidney disease charities in particular have called for the condition to be given higher priority – especially concerning prevention. There is no cure, and treatment options such as dialysis and transplantation are intensive and expensive.
Physical inactivity is a major contributing factor for CKM disease, but one that can have profound effects on health outcomes if improved. Research shows that this patient group are 33 per cent less likely to die, and 21 per cent less likely to need dialysis or a transplant if they exercise2. Maintaining an active lifestyle can slow disease progression, lessening demand for healthcare services.
However, there is a serious shortage of NHS physiotherapists available to tackle this problem. Only three out of 72 kidney units offer dedicated physio-led rehabilitation. Overall, it’s estimated that an additional 12,000 physiotherapists are needed3 to meet the growing needs of an ageing population.
Health and social care secretary Wes Streeting is well aware of the potential for rehabilitation to transform outcomes, noting in the House of Commons: “Rehab is key, not just to good recovery, but prevention of future demand on the NHS too… because rehabilitation is often secondary prevention.”
With an acute workforce shortage, technology offers the only scalable solution. Only digital tools can bring about interventions big enough to meet the avalanche of demand we know is inevitably coming.
The good news is that we have evidence demonstrating the efficacy of a digital CKM rehabilitation programme in improving outcomes, while significantly reducing healthcare costs, in a clinical trial published in The Lancet Digital Health4 and detailed in our white paper, Reimagining rehabilitation for people with cardio-kidney-metabolic conditions – from inactivity to empowerment.
Patients were given access to a specialised 12-week virtual rehabilitation programme created by NHS clinicians from King’s College Hospital, delivered on the Kidney Beam digital platform. Content included online exercise classes, condition-specific education, nutrition advice, and health coaching, delivered by CKM physiotherapists and those with lived experience of the condition.
The trial showed significant improvements in self-reported health-related quality of life, mental health, and self-management. What’s more, a health economic analysis calculated an average reduction in the cost of £580 per patient, with savings driven across outpatient attendances, in-patient days, primary/community/social care touchpoints, accident and emergency attendances, and medication spend.
Using Quality and Outcomes Framework figures, and assuming 10 per cent uptake/30 per cent attrition among the eligible patient population, the programme could save an estimated £143,817,022 for the NHS over three years. And that’s conservative – if every eligible person in the UK were to complete it, the amount could total an astonishing £4.2bn.
Crucially, the programme was evidenced as creating minimal additional workload for existing services, and also in preventing additional demand. It was calculated to be 88 per cent cheaper than standing up a face-to-face service.
We have the technology, and we have the evidence, to bring about a major shift towards prevention and digitalisation for one of the UK’s most prevalent and complex health conditions.
Now, together with our partners at Kidney Research UK, the National Kidney Federation, the UK Kidney Association and several patient groups, we are calling for this solution to be offered UK-wide on the NHS. Our white paper Reimagining rehabilitation for people with cardio-kidney-metabolic conditions – from inactivity to empowerment outlines in full a pivotal opportunity to tackle the CKM crisis and unlock substantial savings – please give it a read and disseminate it to any colleagues to which it is of interest.
Sources
1 Kidney Disease: A UK public health emergency, June 2023, Kidney Research UK
2 Association of Walking with Survival and RRT Among Patients with CKD Stages 3-5. May 2014; Clinical Journal of the American Society of Nephrology
3 Thousands more physiotherapists needed in government’s workforce plan, March 2023, Chartered Society of Physiotherapists
4 Evaluating the effect of a digital health intervention to enhance physical activity in people with CKD: January 2024, The Lancet Digital Health
