Chronic Kidney Disease Pathway Document Description Presented ...

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The diagnosis of CKD is made by assessment of kidney function using estimated Glomerular Filtration Rate (eGFR). eGFR is calculated from serum creatinine levels, but depends on the method of creatinine assay used by each pathology department. Therefore independent calculations of eGFR from previous creatinine results will not give reliable results, as a correction factor needs to be applied for the method used by Dudley group of hospitals pathology dept. There is no need for 24-hour urine collection to measure creatinine clearance in primary care. The method for calculating eGFR is the 4-variable MDRD formula: eGFR (mL/min/1.73m 2 )= 186 x [Serum Creatinine (umol/L) x 0.0113] -1.154 x Age(years) -0.203 (x 0.742 if female) and 1.21 if African Caribbean. An online calculator can be downloaded from: http://www.renal.org/eGFRcalc/GFR.pl N.B. The 4-variable MDRD formula: • Is suitable for adults only (>17 years of age) • Results are unreliable for eGFR > 60 mL/min/1.73m 2 . • Results will NOT reflect true GFR if patient is receiving dialysis therapy. • The formula has not been validated for Asian people. • Results may deviate from true GFR values with extremes of body composition, dietary intake or severe liver disease. • The formula has NOT been validated for drug dosing. Use the Cockcroft and Gault formula Diagnosis of CKD should be made during a period of wellness by measurement of eGFR. Advise the person not to eat meat for at least 12 hours before the eGFR blood test. If the eGFR is < 60 mls/min then the guidance in this pathway should be followed to exclude acute renal failure. A diagnosis of renal impairment should not be made on the basis of one result; at least 2 results should be considered which should be at least 3 months apart. If both of the results are< 60 mls/min then the patient should be considered to have CKD and be added to the practice register. The patient should then be managed following the guidance in this pathway. 18
Return to overview CKD Stages CKD Stage Description 1 Normal eGFR > 90 mL/min/1.73m 2 With other evidence of chronic kidney damage 2 Mild Impairment - 60-89 mL/min/1.73m 2 With other evidence of chronic kidney damage 3 Moderate Impairment - 30-59 mL/min/1.73m 2 3A 45 - 59 3B 44 - 30 4 Severe Impairment – 15-29 mL/min/1.73m 2 5 Established Renal Failure (ERF) < 15 mL/min/1.73m 2 or on dialysis *Other Evidence of Chronic Kidney Damage • Persistent microalbuminuria • Persistent proteinuria • Persistent haematuria (after exclusion of other causes) • Structural abnormalities seen on X-ray (e.g. polycystic kidney disease) • Biopsy proven chronic glomerulonephritis Patients found to have an eGFR of 60-89 mls/min without one of the markers above should not be considered to have CKD as these levels are considered normal and therefore should not be subject to further investigation unless there are additional reasons to do so, e.g. belonging to a high risk group. Prevalence of CKD The prevalence of CKD in at stage 3-5 in the UK based on neoErica data is 4.9% 1 19
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 and 12: Kidney function deteriorates natura
Page 13 and 14: Joint Speciality Committee - Royal
Page 15 and 16: Acute Renal Failure Acute Renal Fai
Page 17: Next Steps Any patient suspected to
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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