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Nicki Thomas Primary care management is seen more and more as an important step to successful treatment of chronic kidney disease. The South West Thames Institute for Renal Research and the South West Thames Renal Unit are playing important roles researching primary care both clinically and scientifically. Dr Hugh Gallagher
Nicki Thomas Hugh Gallagher
Currently we have two main projects in the renal primary care field:
The first project, set up in 2003 by Nicki Thomas, joint BRS/KRUK Research Fellow, is designed to work with patients on an innovative education programme which will empower individual patients to take a greater control of their disease and help them prevent or delay the onset of end stage renal failure and the need for dialysis.

The second project in which both Dr Hugh Gallagher, Consultant Nephrologist at the South West Thames Renal Unit, and Dr Nicki Thomas are involved is a major multicentre project looking at the way care is delivered to renal patients at a primary care trust level (the local management of a patient's routine general healthcare). The three year programme was highlighted at the recent World Kidney Day event at the House of Lords. The projected is entitled "Quality Improvement in chronic kidney disease - a significant challenge for primary care", and aims to: deliver the evidence base for better primary care led interventions; enhance the quality of care; and drive forward new advances in the treatment of chronic kidney disease within the community. This will be achieved through:

  • improved control of blood pressure
  • reduced referral but better liaison with secondary care
  • reduced rate of decline in renal function
  • patient empowerment
  • increased GP confidence in managing chronic kidney disease

Dr Gallagher will serve as joint Primary Investigator of the project. Dr Thomas was successfully interviewed for the position of Project Coordinator and £1.2 million funding has been provided by the Health Foundation and the Edith Murphy Foundation. The project is supported by Kidney Research UK , and sponsored by St George's and University Hospitals of Leicester .


One of SWTIRR’s areas of interest is improving primary care for renal patients. Primary care describes the health services that play a central role in the local community, such as family doctors (GPs) and pharmacists. The government provides “primary care” through Primary Care Trusts (PCTs). PCTs control local healthcare and a total of 152 PCTs cover all parts of England and receive budgets directly from the Department of Health. So rather than supplying the care we are interested in carrying out research into the best way of providing primary care and as you would expect from SWTIRR this is done through a scientific approach. Many people think of a scientific approach as involving laboratory research but there are many different ways of taking a scientific approach to research. The fundamental principles of a scientific approach are based on gathering objective empirical and measurable evidence; examining the evidence in a clear systematic and logical way that allow you to make theories or predictions to explain the data and therefore be able to predict how something works.

Recent figures suggest that chronic kidney disease could affect between 5 and 10 % of the population. Chronic kidney disease can not only lead to kidney failure but also death from cardiovascular diseases. Questions arise about how we can best help people with chronic kidney disease. If this can be done at the level of primary care it will be far better than having to wait till people arrive in hospital.

There are many things which influence whether chronic kidney disease develops into kidney failure. Currently we only partially understand some of these things. One questions is can we use the knowledge we currently have to improve primary care of renal patients, while at the same time continuing our ground breaking laboratory based research which will give us even more knowledge about the mechanisms of the disease.

SWTIRR is interested in carrying out research into aspects of primary care such as patient education and the care plans provided by PCTs.

If pre-dialysis patients are given specialised education programmes will this help them understand their disease better and therefore help them look after themselves better and slow the progression of the disease and consequently prevent or delay them needing dialysis ?

If you get different PCTs to carry out different care programmes such as frequency of urine testing and blood pressure testing and using newer measures of measuring kidney function will this improve the overall care of the renal patients and end up with fewer progressing to dialysis?

These are important questions but difficult to answer with out very carefully planned and sometimes very lengthy studies. But they are important and SWTIRR intends to look at these and similar issues of primary care.