Using Digital Health to Transform Outpatient Care of People with Chronic Kidney Disease

A move towards digital healthcare is a key ambition of the NHS Long term plan. This ambition is largely predicated on the need to find new solutions at scale to meet the needs of the large and growing number of people living with chronic disease. Chronic Kidney Disease (CKD) is a major public health problem. It can progress to end stage renal disease (ESRD) requiring renal replacement therapy which is life-changing for patients and hugely expensive, costing approximately £30,000 per patient per year and accounting for 2% of the NHS budget. It is also a major risk factor for the development of cardiovascular disease, which remains the commonest cause of morbidity and mortality in the UK. About 2.4 million people are known to be affected by CKD but it is estimated that a further 1.2 million cases remain undiagnosed. Current trends indicate that these numbers will increase by 17% over the next decade, leading to a total of 4.8 million people being affected by CKD in 2030. The total cost to the NHS of managing CKD is approximately £1.45 billion. It is estimated that CKD leads to 45,000 premature deaths per year and 100,000 hospitalisation events. Admission of patients with CKD are, on average, 35 days longer than patients without it. CKD is clearly a major burden on the NHS and its users and is a key area upon which to target digital solutions. Furthermore, the interventions which are known to reduce the adverse impacts of CKD can readily be overseen by patients themselves with remote expert guidance. Insightful input to healthcare from motivated patients can be viewed as a resource which has yet to be fully employed to improve outcomes. Use of digital systems has the potential to tap this resource.

In 2020, The Wessex Kidney Centre (WKC) undertook a pilot using a bespoke digital health solution called MyRenalCareTM which was designed in collaboration with Ardia Digital Health Ltd. Its purpose was to transform the way outpatient care is delivered to individuals living with CKD using digital technology to replace traditional clinic-based management. It rapidly became clear within our unit that the technology met its requirements in a limited cohort of patients and, with the advent of the COVID pandemic, the pilot was extended beyond its intended six months. A cohort of 100+ patients are still being managed effectively using the system. We believe that such digital solutions, integrated into a redesigned outpatient system, can deliver healthcare which is both tuned to the needs of patients and financially efficient.

To further understand the use of or lack of use of MyRenalCare solution within the Renal community we need to understand attitudes and opinions of patients and clinicians towards digitalising care and identify the barriers to adopting such technologies. We aim to do this locally, within our region, and nationally, thereby creating a blueprint for what a digital solution should look like, and a framework to delivering such a solution at scale regionally and nationally.