A programme to spread eGFR graph Surveillance for the early Identification, Support and Treatment of people with progressive Chronic Kidney Disease (ASSIST-CKD)

  • Led by Kidney Research UK.
  • Initial implementation in 12–15 pathology laboratories across the UK.
  • Will drive large-scale, measurable, sustainable change that reduces the burden of chronic kidney disease (CKD) and support understanding of the clinical course of CKD by patients and primary care clinicians.
  • Will use a phased approach to implement eGFR cumulative graph surveillance of kidney function, and evaluate late referral for renal replacement, factors that help or hinder implementation, and how the intervention is perceived.

Late presentation for renal replacement therapy remains an important cause of avoidable harm and premature death.

A Shine 2011 project from the Heart of England NHS Foundation Trust (HEFT) involved extending an innovative system for early detection and treatment of patients with diabetes who are at the highest risk of developing end-stage renal disease, and developing software to extract data for patients with low eGFR (kidney function) directly from the laboratory database.

The project allowed for the surveillance of all laboratory results and has proved highly cost-effective, with the rate of patients at HEFT presenting late before starting dialysis being at the lowest in the UK since 2009. Furthermore, since 2005, the number of patients starting dialysis per year has fallen by 16%, compared with an average 8% increase in England.

This ‘Spreading Improvement’ project will build on this model for success and spread it more widely across the UK.

The aim of the intervention is to facilitate early identification of patients with deteriorating kidney function and reduce the incidence of late presentation for dialysis and use of temporary vascular access.

The project involves the phased implementation of eGFR graph surveillance, developing materials to help patients understand the graphs, and linking the graphs to educational resources for health care professionals.

The project is a collaboration between patients, kidney health care practitioners, laboratory scientists, renal commissioners and GPs in a multi-professional improvement network. A dedicated Patient Advisory Group has been set up to ensure the patient voice is strongly represented in all elements of the project.

An independent evaluation will be carried out during this project and will be published once the project has been completed.

Contact information

For more information about this project, please contact members of the project team:

Further reading

Improvement project

Identification of diabetes patients at risk of renal disease

Improvement project

Led by Heart of England NHS Foundation Trust, this project aimed to develop software that trusts...

About this programme


Spreading Improvement


This programme offers £1.5 million funding for approximately 15 projects a year. It aims to generate...

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