Chronic kidney disease (CKD) is a progressive loss of kidney function, and in some cases leads to kidney failure and the need for kidney replacement therapy (KRT). Demand for KRT is growing. Kidney Research UK recently published that in 2023 the economic burden of kidney disease was £7 billion an estimated 3.2% of the total NHS budget.
Providing KRT via dialysis and transplant care requires staff, machines, space and long-term follow-up, so small changes in demand can create big challenges for hospitals, clinics and regional services. While there are opportunities to deliver more effective and equitable models of renal care, the complexity of the system makes it difficult to anticipate their impact and therefore build strong business cases to support them.
To meet this challenge, we turn to simulation modelling – a tool used to mimic real-world systems that enables what-if scenarios to be played out in a risk-free environment. A simulation approach to modelling the renal system provides a way to understand system complexity and investigate which interventions will have most impact on the number of people living with CKD/KRT. The model is designed to complement clinical and operational judgement, support collective decision-making, and provide evidence to inform long-term planning for renal care.
The simulation model covers the whole renal system, from primary care and the progression of CKD in the population, to patient pathways through hospital and community care for those in the KRT system. This allows planners to see both long-term demand trends and the day-to-day pressures on services.
Importantly, the model can test the impact of interventions at different points in the system this includes upstream actions, such as primary prevention, and downstream changes, such as pre-emptive transplantation. For example, the model is being used to project the impact of the roll out of a new CKD drug which could affect the number of patients requiring in-centre dialysis.
This work was funded by and developed with Midlands Kidney Network. The model is allowing the Midlands region to better evidence their plans for renal care and justify system interventions that could relieve pressure in the renal system over the next 10 years.
Both parts of the model are available online. The CKD progression model has a user-friendly interface and the KRT model can be accessed from GitHub while its interface is finalised. The model is now being rolled out in kidney centres across England so regions can plan consistently and compare approaches. Further to this, plans on how sustain the model are being put in place alongside the UK Renal Registry (UKRR) who have agreed to become a partner for future model development.
By improving forecasting and shared planning, this work aims to o help systems respond proactively to rising demand- ensuring people with CKD receive timely, effective, and equitable care as pressures grow.