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

Background Chronic kidney disease (CKD) affects approximately 10% of adults in England. <1% progress to end stage-kidney disease (ESKD), significantly impacting health-related quality of life with high healthcare costs. CKD is associated with cardiovascular disease risk. New therapies to improve outcomes highlight the need for effective risk stratification. Aim To explore primary care teams’ views and experiences of CKD risk stratification. Design and Setting Qualitative interview and focus group study with GP practices in South England, South London and Yorkshire. Method 26 semi-structured interviews with GPs, pharmacists and practice nurses, and 4 focus groups (31 participants) with practice teams including clinical, administration and management staff, February 2024 to January 2025 across 20 practices, informed by normalisation process theory (NPT), using thematic analysis. Results We identified 4 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 over-medicalisation. 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. Conclusion Primary care awareness of CKD is high, but workload, time pressures, and concerns regarding patient anxiety and over-medicalisation contribute to incomplete risk stratification. Refining risk stratification procedures and effective patient communication could improve care.