Identification of diabetes patients at risk of renal disease Heart of England NHS Foundation Trust

The Heart of England NHS Foundation Trust renal team had developed an innovative system for early detection and treatment of diabetic patients at highest risk of developing end stage kidney disease. The renal consultant uses a database containing biochemical data from diabetic patients seen in outpatients to generate cumulative graphs charting up to five years of renal function. These graphs make it possible to identify patients who are deteriorating rapidly, so they can be targeted for intervention. Patients receive care at an earlier stage in their disease, which creates a greater opportunity to control blood pressure and reduce the rate of renal function decline.

The Shine project team wanted to adapt the system so it could be used by other trusts in the region and nationally. This involved developing software capable of:

• combining blood and urine test data and demographic data from multiple laboratory information systems
• extracting data on patients with a low estimated glomerular filtration rate (eGFR) from a trust's biochemical laboratory database
• combining multiple records for patients and adding new patient data daily
• creating cumulative graphs for review by trained clinical laboratory staff.

The new database allows the screening of all patients, whether inpatients or being treated in the community, and enables immediate referral of those showing a steep decline.

Outcomes

The system was successfully tested using historical data and introduced into routine practice at Heart of England NHS Foundation Trust. The team anticipates that, after five years, the system could have generated cost savings of £500,000 through reducing the number of patients needing kidney replacement therapy.