Understanding risk stratification of chronic kidney disease: a qualitative study in primary care

Chronic kidney disease (CKD) affects approximately 10% of adults in England. Of these adults, approximately 1% progress to kidney failure with a significant impact on health-related quality of life and high healthcare costs. CKD is associated with increased cardiovascular disease risk. New therapies to improve outcomes highlight the need for effective risk stratification.

To explore primary care teams' views and experiences of CKD risk stratification.

Qualitative interview and focus group study with GP practices in South England, South London, and Yorkshire.

Twenty-six semi-structured interviews with GPs, pharmacists, and practice nurses, and four focus groups (31 participants) with practice teams including clinical, administration, and management staff were undertaken between January 2024 and January 2025 across 20 practices, informed by normalisation process theory, using thematic analysis.

We identified four key themes: 1) awareness of diagnostic criteria and risk- stratification tools, 2) value of coding CKD and discussion of risk, 3) barriers to CKD risk stratification, 4) improving CKD risk stratification. Despite universal awareness of diagnostic criteria, there was low awareness of risk-stratification tools. Coding was perceived as valuable for health professionals but not for patients. Concerns included increasing patient anxiety and overmedicalisation. Time pressures and lack of incentivisation were perceived as key barriers. Improved healthcare professional education, guidelines, pathways, and technology/automation were highlighted as areas of potential improvement.

Primary care awareness of CKD is high, but workload, time pressures, and concerns regarding patient anxiety/overmedicalisation may contribute to incomplete risk stratification. Refining processes and effective patient communication could improve care.