Carnall Farrar (CF) and Health Innovation Manchester (HInM) have published the first population-level analysis of chronic kidney disease (CKD) and its cardiovascular impact in Greater Manchester.

In Greater Manchester, 43% of CKD cases currently remain undiagnosed. The landmark analysis has provided an important evidence base for a growing programme of prevention and early intervention across Greater Manchester, helping partners identify opportunities to improve diagnosis, treatment, care coordination and wellbeing support for people living with cardiovascular, kidney and metabolic (CVKM) conditions.

CKD: a cardiovascular crisis hiding in plain sight

Chronic kidney disease (CKD) is England’s hidden cardiovascular crisis. It is estimated to impact over 7 million people in the UK and is one of the world’s biggest killers, projected to be the fifth highest cause of life years lost by 2040.¹

Despite contributing to 11% of all cardiovascular deaths, as many as diabetes and more than obesity, CKD attracts no dedicated Quality and Outcomes Framework indicators. The WHO only formally recognised CKD as a major non-communicable disease in 2025.

People living with CKD face a six-fold higher risk of major cardiovascular events. In Greater Manchester alone, 94,000 people are estimated to have CKD and remain undiagnosed, the majority of working age and in the early stages of the disease. Those in the most deprived areas wait nearly three years from clinical evidence of CKD to diagnosis, compared with one year in the least deprived areas, and represent over 50% of all patients on dialysis despite accounting for 20% of the population.

The economic burden escalates sharply as the disease progresses. Annual NHS costs run from £352 per person at stage 1 to £21,794 at stage 5. The total cost of CKD in Greater Manchester’s diagnosed population alone reached £329 million in 2023 and is projected to rise to £381 million by 2033 without intervention.

Greater Manchester: a scalable blueprint for system-level transformation

For the first time, Greater Manchester has a comprehensive population-level view of how kidney disease, cardiovascular disease, diabetes and deprivation interact across communities.

The analysis, the first of its kind at population level in England, integrates national Hospital Episode Statistics and CVDPrevent audit data with a linked primary-secondary care dataset covering 209,328 CKD patients across Greater Manchester.

Greater Manchester is in the early stages of demonstrating what it looks like when a health system translates population-level evidence to support strategic commissioning action. The analysis has provided the system-wide evidence base needed to elevate cardiovascular-kidney-metabolic (CVKM) prevention as a commissioning priority, making the return on investment case for acting earlier with risk stratification, multi morbidity approaches and prevention rather than waiting for expensive, late-stage disease.

This approach aligns strongly with the recent publication of the national Cardiovascular Disease Modern Service Framework (CVD MSF), which calls for a more integrated approach to preventing and managing cardiovascular conditions and their associated co-morbidities, and this analysis provides a practical example of how those ambitions can be translated into action.

The report has provided the system-wide evidence base needed to elevate CVKM as a strategic commissioning priority. The CKD case for change demonstrated that investing in earlier identification and treatment of CKD at stages 2 to 5 costs approximately £23 million annually in additional prescription spend across Greater Manchester. The return, in reduced secondary care admissions, avoided dialysis, and kidney transplant costs, is £45.7 million per year, a net saving of £22.7 million. That is before accounting for the value of more than 2,100 cardiovascular events and 265 deaths prevented each year. For commissioners facing sustained financial pressure, few prevention programmes in the system return at this ratio.

These findings are driving the Circulation Health project, a major new initiative that has launched across Greater Manchester bringing together Health Innovation Manchester, Boehringer Ingelheim, and the Greater Manchester Primary Care Provider Board as part of a Collaborative working project, to help people with and at risk of chronic kidney disease (CKD) and related cardiovascular‑kidney‑metabolic (CVKM) conditions get the care and support they need early. The project has identified approximately 18,000 eligible patients with multiple cardiovascular-renal-metabolic conditions not receiving comprehensive, guideline-aligned care. The project will enable up to 64,800 neighbourhood-led clinical interactions across 20 Primary Care Networks, creating capacity to deliver holistic interventions and reduce health inequalities at scale.

The report’s findings also align closely with Greater Manchester’s wider Prevention Demonstrator ambitions, supporting the shift from reactive treatment to proactive prevention and helping partners target interventions where they can have the greatest impact.

Alongside this, the BeCCoR quality improvement programme is supporting primary care teams to strengthen identification and management of long-term conditions, while the Live Well approach is helping connect people to wider wellbeing, community and behavioural support that addresses the broader determinants of health. Together, these initiatives illustrate how Greater Manchester is bringing together data, prevention, clinical innovation and community support to improve outcomes for local people.

The Greater Manchester model, combining rigorous health economic analysis, integrated data, and a clear pathway from evidence to commissioning decision, offers a practical template for integrated care systems across England seeking to make the shift from reactive to preventive care. By demonstrating how prevention, neighbourhood delivery, data-driven risk stratification and economic evaluation can work together at scale, Greater Manchester is helping to show how the NHS can achieve the long-term shift from reactive care to prevention.

Ben Richardson, CF Managing Partner: “Chronic kidney disease is one of the largest preventable contributors to cardiovascular harm in England, yet it stays largely invisible in how we plan and commission care. By linking primary and secondary care data across Greater Manchester, we can see the scale of the undiagnosed population and the size of the opportunity.”

Laura Rooney, Deputy Chief Executive at Health Innovation Manchester: “CKD too often goes undetected until it has already had a significant impact on people’s lives. The publication of the CVD MSF highlights the growing national recognition that cardiovascular, kidney and metabolic conditions cannot be tackled in isolation, and this analysis brings into focus the real opportunity to change outcomes for patients across Greater Manchester – supporting earlier diagnosis, improving access to effective treatments, and ultimately preventing avoidable cardiovascular harm.

“At Health Innovation Manchester, our role is to bring partners together, across the NHS, academia and industry, to turn this kind of insight into practical action so innovation reaches patients sooner and helps deliver more equitable, preventive care at scale.”

Dr Jim Ritchie, CCIO NHS GM and Consultant Renal Physician: “This analysis shows how Greater Manchester’s real world data can identify opportunities to improve care and reduce inequalities for the citizens of Greater Manchester. Earlier identification and management of CKD supports our strategy to improve the healthy lives of our population and offer the best treatments to everyone.”

Fiona Loud, Policy Director of the UK’s leading kidney patient support charity, Kidney Care UK: “This evidence presents a compelling case for change and now is the time to make that change. With almost half of people with kidney disease in Greater Manchester not knowing that they have it, the region has the chance to change those lives for the better, leading the way to better early identification and treatment. Time and time again people with kidney disease tell us that they wish they had been told about their condition and given advice about what could be done sooner. Not only will this improve their quality of life, but it will also have an economic impact too.

“It’s possible to lose up to 90% of your kidney function without realising, but the sooner someone is diagnosed the more time and opportunities there are to maintain and protect kidney function. With the recently published cardiovascular disease Modern Service Framework highlighting the vital interconnection between cardiovascular, kidney and metabolic conditions this research has come at the perfect time. We look forward to working with Greater Manchester and the wider NHS to see how they can take the report findings and embed them across integrated care systems as part of the 10 year plan to shift from reactive to preventative care.”

Notes to editors

Unless otherwise referenced, all analysis in this press release is extracted from the report: Carnall Farrar and Greater Manchester Integrated Care Board (2026) Chronic Kidney Disease: the case for early diagnosis and treatment. Available at: https://www.carnallfarrar.com/chronic-kidney-disease-case-for-change-in-greater-manchester/.

The analysis was led by CF in close collaboration with clinical leadership from Prof Smeeta Sinha, Consultant Nephrologist, and Prof Gavin Dreyer, Consultant Nephrologist, whose expertise shaped the clinical framing and interpretation throughout.

References

¹Kidney Research UK (2023) Kidney disease: a UK public health emergency – the health economics of kidney disease to 2033. Available at: https://www.kidneyresearchuk.org/wp-content/uploads/2023/06/Economics-of-Kidney-Disease-full-report_accessible.pdf

About the analysis

The CKD Case for Change integrates national Hospital Episode Statistics (2024/25), CVDPrevent audit data, Health Survey for England prevalence estimates, and National Cost Collection reference costs with a linked primary-secondary care dataset of 209,328 CKD patients across Greater Manchester. Scenario models estimating the potential impact of earlier identification and treatment drew on treatment effect sizes from the CREDENCE and DAPA-CKD randomised controlled trials and are presented as illustrations of potential scale. The work was independently certified to ABPI standards, with interests transparently declared.

About CF

CF is a leading consultancy dedicated to making an enduring impact on health and healthcare. We work with leaders and frontline teams to improve health, transform healthcare, embed life science innovation and boost growth through investment. With unmatched access to UK healthcare data and award-winning data science expertise, our team are a driving force for delivering positive and meaningful change.

About Health Innovation Manchester

Health Innovation Manchester is a place-based innovation organisation formed by the health, care, civic and academic leaders of Greater Manchester (GM), Our vision is to be world leading in improving the lives of local people, transforming care and boosting the economy through innovation.

Since our formation in 2017, we have evolved our operating model and method for how we deploy innovation to deliver demonstrable impact and benefits to local people, system partners and industry.

Kidney Care UK resources

Information on Kidney Care UK’s #BloodyAmazingKidneys campaign: https://kidneycareuk.org/bloody-amazing-kidneys/

Kidney Care UK’s free online Kidney Health Checker: https://kidneycareuk.org/kidney-health-checker/

Information on Kidney Care UK’s free patient information resources: https://kidneycareuk.org/get-support/free-resources/

Information on Kidney Care UK’s patient support services: https://kidneycareuk.org/get-support/