• Led by St George’s, University of London and Kidney Research UK.
  • Partnered with the Renal Association and the Royal College of General Practitioners.
  • Ran from 2007 to 2010.
  • Focused on helping GPs identify and manage patients with chronic kidney disease (CKD), a long-standing clinical problem affecting many patients.
  • Used three different quality improvement techniques and a programme of data collection to test changes.



Effective management of chronic kidney disease (CKD) centres on strictly controlling blood pressure to reduce cardiovascular risk and slow the progression of CKD.

The project looked to help patients manage their condition more effectively and provide new research evidence to support patients and their health care teams. The project worked with GPs in 130 practices across south west London, Surrey, Leicester and Manchester, supporting them to better identify and manage patients with chronic kidney disease.

Identifying the techniques that work allows clinicians to flag up patients with declining kidney function and control blood pressure which can delay the need for dialysis or transplantation.

The team used three different quality improvement techniques:

  • a patient empowerment programme to increase patients’ understanding of the disease and its implications for their lifestyle
  • an audit-based education tool used to feed back data to groups of practices about their quality of care, with a local clinical champion presenting comparative data in an educational context
  • a cluster randomised trial (CRT) which aimed to improve blood pressure management for those at risk of renal failure and other associated diseases such as diabetes and cardiovascular disease.

The team found the biggest challenge in quality improvement research was linking cause and effect – ascribing change to interventions to prove they should be rolled out in other areas. To tackle this they collected data at multiple points and linked changes to the dates of interventions.

Further reading