Chronic Kidney Disease Pathway Document Description Presented ...

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Using the existing classification at least 4% of the adult population have stage 3 CKD, many of whom are elderly. They are at increased risk of cardiovascular disease but most will not progress to end stage kidney disease. The priority should therefore be to identify those at risk of kidney disease progression. Persistent proteinuria (protein:creatinine ratio (PCR) > 100 mg/mmol) is the best indicator of risk of progression to ESRD. In diabetic patients urinary albumin /microalbumin estimations should be used. It is recommend that all patients with suspected early CKD should have a urine dipstick for proteinuria and, if positive, quantification of the PCR. This is included in the Quality and Outcomes Framework. Urine albumin:creatinine ratio (ACR) should be used in line with national guidelines in people with diabetes. (Patients undergoing dialysis have the suffix D added to their CKD stage, e.g. 5D. Those who have had a transplant should be classified according to eGFR but have the suffix T added, e.g. 3T) Read Codes 1Z15. CKD stage 3A 1Z16. CKD stage 3B 1Z17. CKD stage 1 with proteinuria / 1P 1Z18. CKD stage 1 without proteinuria 1Z19. CKD stage 2 with proteinuria / 2P 1Z1A. CKD stage 2 without proteinuria 1Z1B. 1Z1C. 1Z1D. 1Z1E. 1Z1F. 1Z1G. 1Z1H. 1Z1J. 1Z1K. 1Z1L. CKD stage 3 with proteinuria / 3P CKD stage 3 without proteinuria CKD stage 3A with proteinuria / 3AP CKD stage 3A without proteinuria CKD stage 3B with proteinuria / 3BP CKD stage 3B without proteinuria CKD stage 4 with proteinuria / 4P CKD stage 4 without proteinuria CKD stage 5 with proteinuria / 5P CKD stage 5 without proteinuria http://www.renal.org/CKDguide/consensus.html References 12
Joint Speciality Committee - Royal College of Physicians, The Renal Association (2006) Chronic Kidney Disease in Adults, UK Guidelines for Identification, Management and Referral. http://www.renal.org/CKDguide/full/CKDprintedfullguide.pdf University Hospital – Leicester (2005) Renal Guidelines Adults with Chronic Kidney Disease http://www.britishrenal.org/Other/RenalGuideline.pdf Department of Health (2005) The National Service Framework for Renal Services: Part Two: Chronic Kidney Disease, Acute Renal Failure and End of Life Care. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicy AndGuidance/DH_4101902 Return to overview 13
Page 1 and 2: Chronic Kidney Disease Pathway Docu
Page 3 and 4: Pathway for the Identification and
Page 5 and 6: Contents Introduction …………
Page 7 and 8: Introduction Chronic kidney disease
Page 9 and 10: CKD Pathway D I A G N O S I S Ensur
Page 11: Kidney function deteriorates natura
Page 15 and 16: Acute Renal Failure Acute Renal Fai
Page 17 and 18: Next Steps Any patient suspected to
Page 19 and 20: Return to overview CKD Stages CKD S
Page 21 and 22: Practice Action Plan Compiling a Ch
Page 23 and 24: Action Rationale Responsible Run a
Page 25 and 26: eGFR
Page 27 and 28: CKD Stages CKD Stage Description Re
Page 29 and 30: References Joint Speciality Committ
Page 31 and 32: Cardiovascular Risk All patients wi
Page 33 and 34: Hypertension Blood pressure should
Page 35 and 36: Further information on the pharmaco
Page 37 and 38: Irbesartan* Valsartan Losartan* *Sp
Page 39 and 40: • Diuretics • Lithium carbonate
Page 41 and 42: Recommendation: Therefore consider
Page 43 and 44: Lower levels of proteinuria should
Page 45 and 46: Glycaemic Control CKD and Diabetes
Page 47 and 48: References Audit Commission (2002)
Page 49 and 50: Influenza and Pneumococcal Vaccine
Page 51 and 52: Stage 3 Management at stage 3 shoul
Page 53 and 54: If all other causes for the anaemia
Page 55 and 56: Clinic inclusion criteria: Patients
Page 57 and 58: Where vitamin D supplementation is
Page 59 and 60: Stage 5 Patients identified at CKD
Page 61 and 62: Information to include with referra
Page 63 and 64:
Appendix 1 The Dudley Group of Hosp
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