Chronic kidney disease is England’s hidden cardiovascular crisis. More than seven million people live with it across the UK, and it is projected to be the fifth highest cause of life years lost worldwide by 2040. And yet CKD attracts no dedicated Quality and Outcomes Framework indicators, while cardiovascular disease carries 16 and diabetes eight. The structural gap between the epidemiological reality and system priority was the opportunity we set out to close.
Working with Health Innovation Manchester and senior NHS clinicians, CF produced the first comprehensive, population-level picture of how CKD drives cardiovascular mortality across England and what earlier intervention could deliver. Our analysis draws on Hospital Episode Statistics (2024/25), CVDPrevent audit data, and a linked primary-secondary care dataset covering 209,328 CKD patients across Greater Manchester. For the first time, Greater Manchester has a comprehensive population-level view of how kidney disease, cardiovascular disease, diabetes and deprivation interact across communities.
Key findings
The scale of the problem in Greater Manchester
In Greater Manchester, 115,000 people carry a CKD diagnosis, around 7% of the adult population. Prevalence rises sharply with age, from 0.6% among 35 to 44 year-olds to more than 30% among those aged 75 and over. Nearly two-thirds of all diagnosed patients are aged 75 or above.
But the diagnosed population is only part of the picture. A further 94,000 people in Greater Manchester are estimated to have CKD and remain undiagnosed, 43% of the total. The majority are of working age and in the early stages of the disease. At stage 1, 94% of patients have no formal diagnosis. Among those over 75, nearly all are diagnosed. The system catches CKD late, in older patients, when the disease has already progressed and the window for earlier intervention has passed.
CKD and cardiovascular risk: a compounding relationship
CKD is not a condition that exists in clinical isolation. People with CKD in Greater Manchester are more than six times more likely to suffer a cardiovascular event (stroke, myocardial infarction, or heart failure) than the general adult population. Risk compounds with disease progression: stage 3 CKD patients experience 306 cardiovascular events per 1,000 people.
The consequences for life expectancy are severe. A 30-year-old diagnosed with stage 3 CKD faces a reduction in life expectancy of approximately nine years; at stage 5, that rises to 21 years. Critically, the majority of CKD patients do not die from kidney failure. They die from cardiovascular disease. At stages 4 and 5, between 50% and 60% of deaths are cardiovascular in origin.
This matters for how CKD is framed clinically and in policy. It is not primarily a renal problem. It is a cardiovascular risk amplifier that sits, largely unrecognised, within the current prevention architecture.
Deprivation deepens every dimension of the problem
Health inequalities run through the CKD picture in Greater Manchester in ways that should concern commissioners directly.
People in the most deprived areas are twice as likely to have CKD compared to those in the least deprived. They face higher mortality from the disease. And they wait significantly longer for a diagnosis: in the most deprived quintile, the average time from clinical evidence of CKD to formal diagnosis is nearly three years. In the least deprived, it is one year. That two-year gap represents two years of untreated cardiovascular risk accumulation.
The downstream consequences are visible in dialysis data. Over 50% of Greater Manchester patients receiving dialysis live in the bottom 20% of deprived areas, a group that represents 20% of the population. Earlier identification and treatment in deprived communities would not just improve outcomes; it would address one of the most persistent structural inequities in NHS care.
The opportunity in taking earlier action
The cost of CKD in Greater Manchester’s diagnosed population reached £329 million in 2023 and is projected to rise by £52 million to £381 million by 2033, a compound annual growth rate of 1.2%. Without intervention, that trajectory is locked in.
Cost rises steeply with disease stage. Annual secondary care costs run from £352 per person at stage 1 to £21,794 at stage 5. Around 21,000 of Greater Manchester’s 115,000 diagnosed patients are admitted to hospital each year; at stage 5, an average patient is admitted 36 times annually.
Importantly, CKD costs are not primarily driven by kidney-related care. CVD accounts for 22% of CKD secondary care resource use, compared to 16% for CKD-related conditions directly. In stages 1 to 4, hospital costs for cardiovascular admissions substantially exceed those for kidney disease. Only at stage 5, where dialysis dominates, do kidney-related costs overtake CVD. This cost structure reinforces the clinical argument: intervening earlier, before cardiovascular complications accumulate, is where the economic and health return is greatest.
The treatment gap: testing and prescribing
Two diagnostic tools are central to identifying and managing CKD early. The eGFR blood test estimates kidney filtration rate; the uACR urine test detects early kidney damage through albumin levels. Both are inexpensive, non-invasive, and clinically decisive. Both are significantly underused in Greater Manchester.
Fewer than half of diagnosed CKD patients at stages 1 and 2 have had a uACR test in the past 12 months. Among younger patients aged 35 to 44, rates are lower still. Only 70% of high-risk individuals, those with hypertension and type 2 diabetes, are being tested for ACR. These are the patients most likely to benefit from early identification, and they are the patients least likely to have been tested.
The prescribing picture is similarly concerning. Over 70% of Greater Manchester’s CKD patients are hypertensive; 33% are diabetic. Both conditions are key drivers of CKD progression. Yet fewer than 50% of diabetic CKD patients are prescribed SGLT2 inhibitors, therapies with strong trial evidence for slowing CKD progression and reducing cardiovascular events.
The CREDENCE trial suggests SGLT2 inhibitor treatment could delay end-stage kidney disease by up to 15 years compared to standard care with renin-angiotensin-aldosterone system inhibitors alone. NICE guidance recommends empagliflozin as an option for adults with CKD meeting specified eGFR and albumin thresholds. Despite this, only 25% of eligible CKD patients in Greater Manchester are currently being prescribed SGLT2 inhibitors. Among patients without diabetes, the prescribing rate falls below 1%, despite NICE recommendations extending eligibility beyond the diabetic population.
What wider treatment could deliver
Our scenario modelling, drawing on treatment effect sizes from the CREDENCE and DAPA-CKD randomised controlled trials, estimates the scale of what systematic earlier intervention could achieve in Greater Manchester.
If SGLT2 inhibitor therapies were prescribed to all eligible CKD patients, Greater Manchester could expect to prevent more than 2,100 major cardiovascular events and save 265 lives per year.
Earlier identification and treatment of the approximately 67,000 patients currently progressing through the disease could generate annual secondary care savings of £28 million and dialysis and kidney transplant savings of £8.7 million, a total of £36.7 million in avoidable costs by 2033. Earlier intervention, prescribed to stage 2 to 5 patients, would cost approximately £23 million annually in additional prescription costs. Against £45.7 million in total annual savings, the net benefit is £22.7 million per year.
Greater Manchester: a scalable blueprint for system-level transformation
This work lands at a moment of growing national recognition that cardiovascular, kidney and metabolic conditions cannot be tackled in isolation. The recently published Cardiovascular Disease Modern Service Framework (CVD MSF) calls for a more integrated approach to preventing and managing cardiovascular conditions and their associated co-morbidities.
The UK government has committed to reducing premature cardiovascular deaths by 25% within a decade, approximately 12,250 fewer deaths annually. Achieving that ambition without addressing CKD is unlikely. CKD contributes to 11% of all cardiovascular deaths in England: as many as diabetes, and more than obesity. The WHO only formally recognised CKD as a major non-communicable disease in 2025. England, through this work, is ahead of most comparable health systems in quantifying the burden.
Greater Manchester is in the early stages of demonstrating what it looks like when a health system translates population-level evidence to support strategic commissioning action. The investment case set out above, for treating CKD earlier rather than managing it once it has progressed, has given the evidence base needed to shift how the system commissions for cardiovascular, renal and metabolic conditions. The aim is to move away from reacting to late-stage disease and toward identifying risk early and acting on it, system-wide.
This is already translating into delivery. The Circulation Health project has launched across Greater Manchester to reach people with, or at risk of, CKD and related CVKM conditions before their disease progresses. It has already identified around 18,000 people with multiple CVKM conditions who are not currently getting comprehensive, guideline-aligned care, and it is building the capacity for up to 64,800 clinical interactions through neighbourhood teams across 20 Primary Care Networks.
This work connects into Greater Manchester’s broader Prevention Demonstrator programme, which is testing how the system shifts from treatment to prevention more widely. The BeCCoR quality improvement programme is helping primary care teams get better at spotting and managing long-term conditions earlier and Live Well is linking people to the community and wellbeing support that often sits behind a CKD diagnosis, addressing the conditions that drive ill health in the first place, not just the disease itself.
These strands show a system trying to join up data, clinical practice, and community support around the same population of people. Taken together, they offer a practical template for integrated care systems across England seeking to make the shift from reactive to preventive care.
This analysis was produced by CF, in partnership with Health Innovation Manchester. Clinical leadership was provided by Professor Smeeta Sinha, Consultant Nephrologist, NHS England, and Prof Gavin Dreyer, Consultant Nephrologist.
FAQs
Notes
Unless otherwise referenced, all analysis in this press release is extracted from the report: Carnall Farrar and Greater Manchester Integrated Care Board (2026) Chronic Kidney Disease: the case for early diagnosis and treatment. Available at: [URL to be added post release]
The analysis was led by CF in close collaboration with clinical leadership from Prof Smeeta Sinha, Consultant Nephrologist, and Prof Gavin Dreyer, Consultant Nephrologist, whose expertise shaped the clinical framing and interpretation throughout.
References
Kidney Research UK (2023) Kidney disease: a UK public health emergency – the health economics of kidney disease to 2033. Available at: https://www.kidneyresearchuk.org/wp-content/uploads/2023/06/Economics-of-Kidney-Disease-full-report_accessible.pdf
Full references listed in the report.
About the analysis
The CKD Case for Change integrates national Hospital Episode Statistics (2024/25), CVDPrevent audit data, Health Survey for England prevalence estimates, and National Cost Collection reference costs with a linked primary-secondary care dataset of 209,328 CKD patients across Greater Manchester. Scenario models estimating the potential impact of earlier identification and treatment drew on treatment effect sizes from the CREDENCE and DAPA-CKD randomised controlled trials and are presented as illustrations of potential scale. The work was independently certified to ABPI standards, with interests transparently declared.
About CF
CF is a leading consultancy dedicated to making an enduring impact on health and healthcare. We work with leaders and frontline teams to improve health, transform healthcare, embed life science innovation and boost growth through investment. With unmatched access to UK healthcare data and award-winning data science expertise, our team are a driving force for delivering positive and meaningful change.
About Health Innovation Manchester
Health Innovation Manchester is a place-based innovation organisation formed by the health, care, civic and academic leaders of Greater Manchester (GM), Our vision is to be world leading in improving the lives of local people, transforming care and boosting the economy through innovation. Since our formation in 2017, we have evolved our operating model and method for how we deploy innovation to deliver demonstrable impact and benefits to local people, system partners and industry.
About the authors
Ben Richardson
Ben Richardson is a Managing Partner at CF, leading Life Sciences and Data Innovation. With two decades of experience, he has worked with health systems and life sciences companies globally, focusing on strategy, transformation, and development. Ben has contributed to primary care, diabetes, cardiovascular, cancer, mental health, and population health management. Since 2014, he has helped CF become an award-winning healthcare company in management consulting and data services.
Dr Alisa Kamynina
Alisa is a Consultant at CF, her focus is on supporting healthcare systems and life sciences organisations with evidence-based strategies. With a PhD in cardiovascular research and over a decade of expertise in life sciences, she has a strong research background in cardiovascular disease, hypertension, heart failure, and metabolic conditions such as obesity and diabetes background, giving her an expert foundation in translating complex data and insights into practical solutions for healthcare challenges.
Dr Jo Andrews
Dr Jo Andrews is a Partner at CF, his focus is on clinical strategy development, pathway and transformation, and workforce planning across our NHS, life sciences and data innovation practices. With 23 years as a practising clinician and experience across a number of senior NHS leadership roles he brings a clinically grounded perspective to complex service change. Engaging and developing clinical leaders is central to his approach, giving him an expert foundation in delivering sustainable change that improves the lives of patients and staff in healthcare.
Kidney Care UK resources
- For information on Kidney Care UK’s #BloodyAmazingKidneys campaign, click here.
- For Kidney Care UK’s free online Kidney Health Checker, click here.
- For information on Kidney Care UK’s free patient information resources, click here.
- For information on Kidney Care UK’s patient support services, click here.
