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4.1 Pre-Dialysis - Retarding Progression and Reducing the Comorbid Burden in Renal Disease 4.1.5 Interface with Primary Care Local solutions will be required to deliver health improvements in patients at an early stage in their disease or in those patients who have not yet developed full-blown renal disease. The NHS and partner agencies should therefore develop, implement and monitor policies that reduce the prevalence of risk factors in the population. Important among these are the reduction in prevalence of smoking and of diabetes through reduced obesity rates. An important target group is the Asian minority. There is clearly a need to engage all stakeholders including those in health promotion and management. It is hoped that the extra resources which Primary Care will require to impact on the prevalence of coronary artery disease may go some way to ameliorate the burden of renal disease. Primary Care needs good IT systems and close co-ordination with diabetic clinics. Additional resources are needed for the increased use of effective medicines particularly ACE inhibitors in diabetes. Elaboration of the wider responsibilities of primary, secondary and tertiary care towards the patient with ESRF is included in Section 5.3. Link to National Service Standard 1  |