Pharmacist-Led CKD Clinics in Primary Care: Improving Outcomes and Reducing NHS Cost

Swansea Bay University Health Board

Project summary

This project describes the development and delivery of a pharmacist-led Chronic Kidney Disease (CKD) clinic within primary care, designed to improve early identification and optimisation of high-risk CKD patients.

CKD prevalence is increasing and is associated with significant morbidity, mortality, and NHS cost burden, particularly through progression to end-stage kidney disease (ESKD), cardiovascular events, and diabetes-related complications. A key issue identified locally was delayed optimisation of modifiable risk factors, with many patients referred to secondary care despite having reversible or manageable causes such as uncontrolled hypertension, suboptimal diabetes control, or inappropriate medicines.

The pharmacist-led clinic was established to triage patients referred to renal services and provide targeted intervention in primary care. Patients deemed suitable by the renal consultant were managed directly within the clinic, enabling faster access to care and improved patient education.

Interventions included initiation of SGLT2 inhibitors and ACE inhibitors/ARBs, statin initiation in line with NICE CKD guidance, optimisation of blood pressure and glycaemic control, deprescribing of nephrotoxic medicines (e.g. NSAIDs), and referral to smoking cessation services.

A service evaluation of approximately 45 patients demonstrated measurable improvements in all key cardio–renal–metabolic parameters. Mean systolic blood pressure reduced by 7.4 mmHg, HbA1c reduced by 5.1 mmol/mol, and albuminuria-associated kidney risk reduced by approximately 9% relative. In addition, high-risk medication use was eliminated in 16% of patients, and smoking cessation achieved in 7%.

Using NHS-aligned cost estimates, this translated to an estimated annual cost avoidance of £88,000–£154,500 per 45 patients, driven by reduced risk of dialysis, cardiovascular events, diabetes complications and acute kidney injury.

The clinic also freed consultant capacity, reduced outpatient waiting times, and improved patient access to specialist input.

This project demonstrates that a pharmacist-led CKD model in primary care is a high-value, scalable intervention delivering significant clinical benefit, improved patient outcomes, and substantial return on investment.