The great majority of patients starting renal replacement therapy (RRT) have progressed from earlier stages of chronic kidney disease (CKD): most could therefore have been identified earlier, with possible improvements in outcome. Although end-stage renal disease (ESRD) is relatively rare, treatment with dialysis or transplantation is very expensive, currently costing over 2 % of the total National Health Service (NHS) budget. Any improvement in the early identification and management of CKD is therefore highly desirable. Recent years have seen kidney disease move up the health-political agenda in the United Kingdom (UK). This process began with the publication of the National Service Framework (NSF) for Renal Services, which was underpinned by UK guidelines for the identification, management and referral of CKD in adults. Implementation of these strategies was encouraged by a national roll-out of estimated glomerular filtration rate (eGFR) reporting and by paying primary care physicians an incentive to identify CKD through the inclusion of a renal domain in the Quality and Outcomes Framework (QOF). National variation in eGFR reporting was addressed through a UK National External Quality Assessment Scheme (UKNEQAS) "harmonization" process. In autumn 2008, it is anticipated that the National Institute for Health and Clinical Excellence (NICE) will publish its clinical guidelines on CKD.