SPOT-ing CKD in community pharmacy

In Clinical update

Follow this topic

Bookmark

Record learning outcomes

About 7.2 million people in the UK live with chronic kidney disease (CKD), according to Kidney Care UK. The charity adds that between 40,000 and 45,000 people die prematurely from CKD each year.

“CKD can be a silent condition: people can have significant kidney impairment without knowing,” says Arjun Grewal, primary care services lead pharmacist, Hampshire and Isle of Wight Healthcare NHS Foundation Trust. “Moreover, CKD is closely linked with diabetes, hypertension and cardiovascular disease. So, kidney health should be part of routine long-term management in the community.”

SPOT CKD (Screening, Prevention, Outreach and Treatment of Chronic Kidney Disease for Health Equity), a pharmacist-led programme in primary care, “combines patient education, community outreach, earlier detection initiatives and healthcare professional training to support more proactive, equitable kidney care”, he says.

“The early results from SPOT CKD are encouraging,” says Nadia Malik, clinical pharmacist independent prescriber, Health Innovation North East and North Cumbria (HI NENC), speaking for the SPOT CKD partners. “SPOT CKD identified patients who have either not previously been identified or whose CKD has not been accurately coded and, thus, not treated appropriately.”

“SPOT CKD uses evidence-based tools designed by the Clinical Digital Research Collaborative to proactively identify people who have CKD risk factors, but are neither currently diagnosed nor coded. We then work with practices to arrange the appropriate blood and urine tests, and identify those who need further assessment,” Grewal adds.

“Finding CKD is only the first step. Once we identify CKD, pharmacists actively review and optimise treatment in line with local guidelines. We are not simply finding more disease. We are using the diagnosis as an opportunity to change the patient’s trajectory by optimising their blood pressure management with angiotensin-converting enzyme inhibitors [ACE-Is] or angiotensin II receptor blockers [ARBs], or escalating treatment to sodium-glucose co-transporter-2 inhibitors [SGLT2-Is],” he explains.

Promising results

SPOT CKD is a collaboration between Boehringer Ingelheim, NHS North East and North Cumbria Integrated Care Board, HI NENC and NHS Hampshire and Isle of Wight ICB.

“Between November 2025 and May 2026, SPOT CKD identified more than 1,735 patients needing a code correction. Across seven GP practices, CKD diagnoses increased by 7%, with one practice seeing an increase of 24% between November 2025 and April 2026,” says Malik, who is also the practice pharmacist at the Queens Park Medical Centre, Stockton-on-Tees.

SPOT CKD also found gaps in urinary albumin-to-creatinine ratio (uACR) testing, blood pressure management and medicines optimisation. SGLT2-I prescribing rose by 35% between the period of November 2025 to April 2026.

“Once patients are identified, the programme runs integrated multidisciplinary team [MDT] meetings, enabling clinical pharmacists to collaborate on cases involving complex, multimorbid patients with nephrologists and other experts. Through 14 MDT sessions, 44 referrals to specialist kidney services were avoided, while 35 GP appointments were freed up,” Malik comments.

“We are developing a process that can be sustained. We are building CKD into routine long-term condition management and strengthening the skills within practices so that identification and management can continue, which for me is the real success from this project,” Grewal adds.

Community pharmacists underused

Malik adds that community pharmacists have not realised their potential in renal care. “Community pharmacists are easy to access, yet they remain underused in CKD case-finding and optimisation,” she says.

“Point-of-care uACR testing in community pharmacy could be a genuine game-changer: uACR remains one of the most under-tested markers in primary care,” Malik says. “Community pharmacy is well placed to close that gap: a patient collecting a repeat prescription for their diabetes or hypertension medication could have a uACR point-of-care test done opportunistically, without needing a separate GP appointment.”

“I would encourage community pharmacists to think about kidney health when they are reviewing patients with cardiovascular, renal and metabolic disease, particularly if they are taking multiple medicines,” Grewal adds.

“Pharmacists should signpost patients to their GP or primary care team for assessment if a patient tells you their kidney function is declining or if there are concerns about their renal function, medicines, a change in their clinical condition or the pattern of CKD risk factors [Table 1]. Community pharmacists see these patients regularly, so are in a good position to notice when something has changed or when a patient may need a clinical review,” Grewal suggests.

“I would encourage pharmacists not to think about CKD purely as a test result [Table 2]. Look at the patient as a whole. Are they taking their medicines as intended? Have there been recent changes? Are there opportunities to optimise their cardiovascular or renal protection? You don’t necessarily need to diagnose kidney disease in community pharmacy. Recognising that something may need investigating and getting the patient to the right person at the right time can be incredibly valuable,” Grewal says.

As Malik concludes: “You don’t have to be a renal specialist to make a difference to kidney disease. You just have to know what to SPOT.”