A quarter of people with diabetes are not getting an annual check that is vital for picking up the early signs of kidney failure, according to a new analysis by Diabetes UK.
According to the analysis, based on National Diabetes Audit data, 25 per cent of people with diabetes in England were not recorded as having the urine check (called a urinary albumin) during 2010/11. The situation is only slightly better in Wales, where 21.6 per cent did not get a check during the same period.
Kidney failure is common in people with diabetes, but checking the urine for the presence of a protein called albumin can give an early warning of kidney damage, allowing people to be given treatment to help stop it getting worse. Unless people get this urine check, they are unlikely to find out they have kidney damage until it has already developed into an extremely serious health issue.
The urine check is one of the two checks people with diabetes should have every year to screen for kidney complications. The other part of the screening is a blood test to show how well the kidneys are working – the percentage of people with diabetes who have the blood test is much higher than for the urine test.
Increased risk of kidney failure
We are concerned that the large number of people not getting the urine check – and a quarter of people with diabetes equates to 750,000 people – are at increased risk of serious kidney failure. Rates of diabetes-related kidney failure at now at record levels: 9,753 people with diabetes in England and Wales needed renal replacement therapy during 2010/11.
We want people with diabetes to make sure they receive both the urine and blood tests, and to be aware of kidney disease and how to reduce their risk of it. A urine sample needs to be taken to the appointment: people forgetting to bring one is thought to be one of the reasons so few people are getting them.
We are also calling on the NHS to be more proactive in offering the checks, and in reminding people about the need to bring a urine sample. Many GP practices are already giving the urine check to over 90 per cent of people with diabetes, and there is no reason the NHS cannot achieve this across the country.
"Devastating impact" on quality of life
Barbara Young, Chief Executive of Diabetes UK, said, "It is really worrying that a quarter of people with diabetes are missing out on a simple check that could identify kidney problems early enough to slow their progression.
"Kidney failure might not worry people with diabetes as much as other complications such as blindness and amputation, but it can have an equally devastating impact on quality of life. All those people who are not getting this check are at increased risk of needing dialysis and ultimately of dying early. By increasing the number of people with diabetes getting these checks, we can help ensure they get treatment for any kidney problems early enough to give them the best possible chance of delaying progression.
"This, as well as reducing people’s risk of developing problems in the first place by supporting them to keep their blood glucose and blood pressure at healthy levels, could make a real difference to the number of people with diabetes whose lives are devastated by kidney failure.
"As well as being tragic for the person involved, kidney failure is also extremely expensive to treat, and the high level of diabetes-related kidney failure is one of the reasons diabetes costs 10 per cent of the entire NHS budget. This means that for both people with diabetes and for an NHS that is under severe financial pressure, the case for increasing the number of people getting these kidney checks is unanswerable.
Understanding the seriousness
"Healthcare professionals need to make sure people with diabetes understand the seriousness of kidney failure, increase awareness of why the urine sample is so important and then act quickly on any problems they identify. It is also important that people with diabetes make sure they take a urine sample with them to their appointment – doing so could literally save their life."
Having an annual urinary albumin is one of Diabetes UK’s 15 healthcare essentials, which sets out the care everyone with diabetes should be getting.