Introduction and overview

Introduction and overview

This quality standard covers identification, assessment and clinical management of chronic kidney disease (CKD) in adults including the management of established renal failure.

It has been revised to ensure alignment with the updated NICE guideline on chronic kidney disease (NICE guideline CG182), which replaced the original development source (NICE guideline CG73) for this quality standard. NICE quality standards are revised when minor amendments are needed to ensure consistency with updated NICE and NICE‑accredited source guidance or to address overlap between quality standard topics.

Quality statements 11–15 in this quality standard have been replaced by statements 2–6 in renal replacement therapy services (NICE quality standard 72).


Chronic kidney disease describes abnormal kidney function and/or structure. It is common, frequently unrecognised and often exists together with other conditions (for example, cardiovascular disease and diabetes). The Health Survey for England 2009 estimated that the prevalence of adult CKD in England was around 13%. The risk of developing CKD increases with increasing age, and some conditions that coexist with CKD become more severe as kidney dysfunction advances. CKD is usually characterised by an asymptomatic period, which is potentially detectable. Tests for detecting CKD are both simple and widely available and there is evidence that treatment can prevent or delay progression of CKD, reduce or prevent the development of complications, and reduce the risk of cardiovascular disease. In cases where progression cannot be prevented, CKD may progress to established renal failure, requiring life‑saving dialysis or kidney transplant.

Chronic kidney disease in adults often exists together with other conditions (for example, cardiovascular disease and diabetes) and when advanced, carries a high risk of mortality. This quality standard describes markers of high‑quality, cost‑effective care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for adults with chronic kidney disease in the following ways:

  • Preventing people from dying prematurely.

  • Enhancing quality of life for people with long‑term conditions.

  • Helping people to recover from episodes of ill health or following injury.

  • Ensuring that people have a positive experience of care.

  • Treating and caring for people in a safe environment and protecting them from avoidable harm.

The NHS Outcomes Framework 2011/12 is available from


The quality standard for CKD in adults requires that services should be commissioned from and coordinated across all relevant agencies encompassing the whole CKD care pathway. An integrated approach to provision of services is fundamental to the delivery of high quality care to people with CKD.

Unless otherwise stated, the term CKD in this quality standard describes collectively stages 1 to 5 of CKD. See development sources for details.