Chronic Kidney Disease Pathway Document Description Presented ...

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of statins such as HPS and ASCOT excluded patients with CKD therefore reliable evidence is not available. The Study of Heart and Renal Protection (SHARP) with a cohort of over 9000 patients will hopefully provide the evidence required. Until then, patients with CKD and no cardiovascular disease or diabetes should be treated with a statin if their 10 year CVD risk is > 20% (Renal Association). However, tables for calculating risk of CVD are not recommended for use in patients with CKD, but it would follow that due to their presenting condition, they would be considered at high risk of cardiovascular disease. Antiplatelet therapy Aspirin should be considered for all patients with an estimated 10 year risk of Cardiovascular (CVD) disease of >20%, so long as blood pressure is 50 o Calculated to have a 10 year CVD risk of > 20% Health Economy Formulary Drug of Choice - aspirin dispersible 75mg OD See Aspirin Initiation Protocol Also see: Hypertension Lifestyle Primary Prevention of Cardiovascular <strong>Disease</strong> Protocol Return to overview 32
Hypertension Blood pressure should be measured by a health care professional who has undergone training, using a machine which is regularly serviced and calibrated. The patient should be seated comfortably and relaxed with: • arm supported at chest level • ensuring correct cuff size is used ie. inner bladder fits 80 – 100% of the circumference of the upper arm. On the first visit: • BP should be measured in both arms and the arm with the higher reading used. This arm can then be noted and used for each subsequent visit. • At least 2 readings should be taken, with an interval of at least a minute between readings and an average of the readings recorded. • If the BP is above treatment threshold, (either systolic, diastolic, or both) check the BP again at the end of the consultation or after a short interval of 5 – 10 minutes, where patient remains seated comfortably. Target BP Range in CKD Aim for: Systolic of
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 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: Cardiovascular Risk All patients wi
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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