Chronic Kidney Disease Pathway Document Description Presented ...

Kidney function deteriorates naturally with age. However the conditions above
may cause the kidneys to deteriorate more rapidly. Careful management of
progressing factors (see pathway) could ensure a normal or close to
normal/expected pattern of deterioration.
Kidney function by eGFR measurement should be monitored annually in the high
risk groups identified above.
Frequency of monitoring of Kidney function in CKD is indicated by the table
below.
Frequency of Monitoring of Kidney Function in Established CKD
K/DOQI eGFR
Frequency
Stage mls/min
1 > 90 Annually
2 60 - 89 Annually
3 30 - 59 Annually
(6 monthly if newly diagnosed or progressive**)
4 15 - 29 6 monthly
(3 monthly if newly diagnosed or progressive**)
5 < 15 3 monthly
Stable kidney function is defined as a change of < 2mls/min in 6 months
** Progressive kidney function is defined as a change of > 2mls/min in 6 months
Any patient assessed with a progressive condition should receive assessment of
progressing factors and discussion/referral to nephrology services.
Stage 3 Classification
The UK Consensus Conference on early CKD has recommended that the Kidney
Disease Outcomes Quality Initiative (KDOQI) classification should be modified by
dividing CKD stage 3 into CKD 3A and 3B and that a suffix “p” should be used for
all stages to denote patients with urine protein to creatinine ratio >100mg/mmol,
who are at increased risk for progression and/or the development of
cardiovascular disease e.g. CKD stages 2p, 3Bp.
CKD stage 3 is sub-classified into 2 groups, 3A and 3B.
Stage eGFR Progression to ESRD
3A 45 - 59 Lower risk
3B 44 - 30 Higher risk
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