Philip A. Kalra

Salford Royal Hospital

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i-10 index

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Darren Green

University of Manchester

Rajkumar Chinnadurai

University of Manchester

Ibrahim Ali

Salford Royal Hospital

Smeeta Sinha

Manchester Academic Health Science Centre

Sunil Bhandari

University of Hull

Kate Bramham

King's College Hospital NHS Foundation Trust

Sharlene A. Greenwood

King's College Hospital

Dónal O’Donoghue

Cleveland Clinic

Kieran McCafferty

Barts Health NHS Trust

Rachel Middleton

University of Manchester

Cooperative Institutions

University of Manchester

University of Oxford

Association for Research and Industrial Development of Natural Resources

Manchester Academic Health Science Centre

Salford Royal NHS Foundation Trust

RELX Group (United States)

Johns Hopkins University

Salford Royal Hospital

University College London

University of Washington

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Uncoded chronic kidney disease prevalence in secondary care: a retrospective audit with population health implications

BMC Nephrology (2025)

Samantha Dolan Ajitesh Anand Philip A. Kalra Stuart Stewart

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Medical record

Nephrology

10.1186/s12882-025-03967-x

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Citations (0)

Serum Phosphorus Levels Associate with Coronary Atherosclerosis in Young Adults

Journal of the American Society of Nephrology (2008)

Robert N. Foley Allan J. Collins Charles A. Herzog Areef Ishani Philip A. Kalra

Phosphorus levels correlate with atherosclerosis in both animal models and humans with advanced chronic kidney disease, but whether this relationship exists among individuals with normal kidney function is unknown. This study aimed to determine whether an association exists between phosphorus levels and coronary artery calcium levels in a community-based cohort of 3015 healthy young adults in the prospective Coronary Artery Risk Development in Young Adults (CARDIA) study. Phosphorus levels were measured at baseline, and presence of coronary artery calcium was assessed by computed tomography 15 yr later. Mean age at study inception was 25.2 yr, and the mean levels of phosphorus and calcium were 3.6 and 9.5 mg/dl, respectively. Only 0.2% of participants had estimated GFR <60 ml/min per 1.73 m². Phosphorus levels were associated with coronary artery calcium in unadjusted models. In multivariate models, however, phosphorus levels were significantly associated with the category of coronary artery calcium level. In conclusion, higher serum phosphorus levels, even within the normal range, may be a risk factor for coronary artery atherosclerosis in healthy young adults.

Coronary atherosclerosis

10.1681/asn.2008020141

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Citations (361)

Personalised Care in CKD: Moving Beyond Traditional Biomarkers

The Nephron journals/Nephron journals (2025)

Thomas McDonnell Rosamonde E. Banks Maarten W. Taal Nicolas Vuilleumier Philip A. Kalra

The ultimate goal of precision medicine is to tailor treatment to specific disease processes, thereby optimising patient outcomes. This approach moves beyond the one-size-fits-all model, recognising at an individual level the unique combinations of molecular, genetic, and environmental factors determining disease progression and treatment response. Chronic kidney disease (CKD) exemplifies the need for precision medicine, given its complex and heterogeneous nature. Traditional biomarkers, such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR), have long been the cornerstone of CKD diagnosis and management. However, these markers homogenise a diverse group of distinct conditions within CKD with separate pathophysiologies and progression rates. The standardisation of CKD definition has improved clarity and consistency but has inadvertently led to a generic classification system, which categorises patients with CKD based on these non-specific markers and fails to capture the nuances of individual patient conditions. As a result, there is a critical need for novel biomarkers that can more accurately represent specific aetiologies and mechanisms of CKD progression. By identifying and utilising novel biomarkers, the field of nephrology could better understand individual mechanisms of CKD progression and move towards tailored risk prediction and treatment strategies, ultimately improving patient outcomes. This review is not intended to be a comprehensive review of all biomarkers in CKD but a proposal to the nephrology community to think more pathophysiologically about CKD, recognise the importance of distinct primary kidney diseases, and start working towards a more personalised medicine approach.

Nephrology

Personalized Medicine

10.1159/000543640

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Chronic kidney disease: detect, diagnose, disclose—a UK primary care perspective of barriers and enablers to effective kidney care

BMC Medicine (2024)

Stuart Stewart Philip A. Kalra Thomas Blakeman Evangelos Kontopantelis Howard Cranmer-Gordon

Abstract Chronic kidney disease (CKD) is a global public health problem with major human and economic consequences. Despite advances in clinical guidelines, classification systems and evidence-based treatments, CKD remains underdiagnosed and undertreated and is predicted to be the fifth leading cause of death globally by 2040. This review aims to identify barriers and enablers to the effective detection, diagnosis, disclosure and management of CKD since the introduction of the Kidney Disease Outcomes Quality Initiative (KDOQI) classification in 2002, advocating for a renewed approach in response to updated Kidney Disease: Improving Global Outcomes (KDIGO) 2024 clinical guidelines. The last two decades of improvements in CKD care in the UK are underpinned by international adoption of the KDIGO classification system, mixed adoption of evidence-based treatments and research informed clinical guidelines and policy. Interpretation of evidence within clinical and academic communities has stimulated significant debate of how best to implement such evidence which has frequently fuelled and frustratingly forestalled progress in CKD care. Key enablers of effective CKD care include clinical classification systems (KDIGO), evidence-based treatments, electronic health record tools, financially incentivised care, medical education and policy changes. Barriers to effective CKD care are extensive; key barriers include clinician concerns regarding overdiagnosis, a lack of financially incentivised care in primary care, complex clinical guidelines, managing CKD in the context of multimorbidity, bureaucratic burden in primary care, underutilisation of sodium-glucose co-transporter-2 inhibitor (SGLT2i) medications, insufficient medical education in CKD, and most recently – a sustained disruption to routine CKD care during and after the COVID-19 pandemic. Future CKD care in UK primary care must be informed by lessons of the last two decades. Making step change, over incremental improvements in CKD care at scale requires a renewed approach that addresses key barriers to detection, diagnosis, disclosure and management across traditional boundaries of healthcare, social care, and public health. Improved coding accuracy in primary care, increased use of SGLT2i medications, and risk-based care offer promising, cost-effective avenues to improve patient and population-level kidney health. Financial incentives generally improve achievement of care quality indicators – a review of financial and non-financial incentives in CKD care is urgently needed.

Overdiagnosis

10.1186/s12916-024-03555-0

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Citations (2)

Predictive Factors of Rapid Linear Renal Progression and Mortality in Patients with Chronic Kidney Disease

Research Square (Research Square) (2020)

Ibrahim Ali Rajkumar Chinnadurai Sara T. Ibrahim Darren Green Philip A. Kalra

Abstract Background: Risk factors predictive of rapid linear chronic kidney disease (CKD) progression and its associations with end-stage renal disease (ESRD) and mortality requires further exploration, particularly as patients with linear eGFR trajectory represent a clear paradigm for understanding true CKD progression. Methods: A linear regression slope was applied to all outpatient estimated glomerular filtration rate (eGFR) values for patients in the Salford Kidney Study who had ≥ 2 years follow-up, ≥ 4 eGFR values and baseline CKD stages 3a-4. An eGFR slope (ΔeGFR) of ≤-4 ml/min/1.73 m 2 /yr defined rapid progressors, whereas − 0.5 to + 0.5 ml/min/1.73 m 2 /yr defined stable patients. Binary logistic regression was utilised to explore variables associated with rapid progression and Cox proportional hazards model to determine predictors for mortality prior to ESRD. Results: There were 157 rapid progressors (median ΔeGFR − 5.93 ml/min/1.73 m 2 /yr) and 179 stable patients (median ΔeGFR − 0.03 ml/min/1.73 m 2 /yr). Over 5 years, rapid progressors had an annual rate of mortality or ESRD of 47 per 100 patients compared with 6 per 100 stable patients. Factors associated with rapid progression included younger age, female gender, higher diastolic pressure, higher total cholesterol:high density lipoprotein ratio, lower albumin, lower haemoglobin and a urine protein:creatinine ratio of > 50 g/mol. The latter three factors were also predictive of mortality prior to ESRD, along with older age, smoking, peripheral vascular disease and heart failure. Conclusions: There is a heterogenous interplay of risk factors associated with rapid linear CKD progression and mortality in patients with CKD. Furthermore, rapid progressors have high rates of adverse outcomes and require close specialist monitoring.

10.21203/rs.3.rs-25163/v1

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Citations (1)

Body mass index has no effect on rate of progression of chronic kidney disease in non-diabetic subjects

Nephrology Dialysis Transplantation (2012)

R. N. K. L. Brown Amira Mohsen Darren Green Richard Hoefield L. K. M. Summers

Chronic kidney disease (CKD) is increasingly prevalent worldwide. Furthermore, obesity is now a global problem with major health implications. There is a clear association between obesity and the development of CKD but it is not known whether obesity is a risk factor for the progression of pre-existing kidney disease. We examined the relationship between the body mass index (BMI) and the rate of progression of CKD in non-diabetic adults.The Chronic Renal Insufficiency Standards Implementation Study (CRISIS) is a prospective observational study in a predominantly white population in Greater Manchester. From the CRISIS database, we assessed rate of progression of CKD in 499 adults attending the hospital. Baseline measurements including BMI were obtained and estimated glomerular filtration rate (eGFR) was monitored. The rate of deterioration of eGFR was derived over time, defined as ΔeGFR (mL/min/1.73 m2/year) and assessed using univariate analysis of variance.In the groups as a whole, no relationship between BMI and ΔeGFR was shown. Dividing the subjects into obese (BMI≥30) and non-obese (BMI<30) groups and further breakdown into CKD stages 3, 4 and 5, also showed no relationship between BMI and ΔeGFR. Univariate analysis of variance was used.Neither BMI as a continuous variable nor obesity (BMI≥30) as a categorical variable was associated with an increased rate of progression of existing CKD in this predominantly white population.

Univariate analysis

10.1093/ndt/gfr757

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Citations (33)