Implementation of NICE-Recommended Chronic Kidney Disease Surveillance in North-East London: Quantifying Gaps, Understanding Barriers, and Estimating the Health and Economic Benefits of Improvement

People with type 2 diabetes (T2DM) and high blood pressure are at higher risk of developing chronic kidney disease (CKD). CKD often develops silently, without symptoms, and many people are not diagnosed until the disease has become more advanced. To support earlier diagnosis, NHS guidelines recommend regular blood tests to measure kidney function and urine tests to detect kidney damage. However, it is unclear how consistently these tests are carried out in routine practice, whether some groups are less likely to receive recommended monitoring, and whether differences in monitoring affect when CKD is identified.

This PhD project aims to understand how CKD surveillance is delivered among people with T2DM and hypertension in North-East London, one of the most ethnically diverse and socioeconomically deprived regions in England. The student will use securely held, anonymised NHS primary care records to examine patterns of kidney surveillance over time. The student will investigate how often recommended blood and urine tests are performed, how monitoring varies according to age, sex, ethnicity and deprivation, and whether more consistent monitoring is associated with earlier identification of CKD and more timely treatment. The student will also conduct interviews with healthcare professionals, commissioners and kidney specialists to understand barriers and facilitators to implementing recommended kidney monitoring in primary care. Finally, health economic modelling will be used to estimate the potential benefits of improving CKD surveillance and reducing inequalities in care.

The student will develop skills in epidemiology, health data science, advanced statistical modelling, qualitative research, implementation science and health economics. Findings from the project will help identify practical ways to improve early detection of CKD, reduce inequalities in kidney care, and support better outcomes for people living with diabetes and hypertension in North-East London.