Chronic Kidney Disease Pathway Document Description Presented ...

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If BP is above threshold, check this reading on 2 more visits 2 – 4 weeks apart or check home readings. If the BP trend is found to be above the treatment threshold as stated, a decision on initiating pharmacological management should be made. Inhibition or blockade of the renin/angiotensin/aldosterone system with ACE inhibitors or ARBs has been found to confer renal and cardio protection over and above the effects of their BP lowering effect. For this reason they are recommended as first line treatment for people with CKD. See Initiation of ACE/ARB. See Renal artery stenosis For non-pharmacological management discuss lifestyle measures as detailed in the “Best Practice Guidelines for Lifestyle Assessment” with particular attention to salt content in the diet and also in prescribed or OTC drugs. Note that in the checklist below for those with CKD the dietary advice differs from that which is usually recommended: • Fruit and vegetables are to be at a maximum of 5 portions a day due to their potassium content • Oily fish should be one portion only per week due to high phosphate levels. Lifestyle Measures Checklist • Stop smoking • Correct dyslipidaemia • Screen for diabetes • Maintain normal weight for adults (body mass index 20-25 kg/m2) • Avoid central obesity
Further information on the pharmacological management of hypertension can be found in the: “Dudley Guidelines for the Pharmacological Management of Hypertension”, http://joint.dudley.nhs.uk/cmsextra/documents/cms/222-2007-12-19-5392411.pdf For further information on taking blood pressure measurements, guides using electronic machines and anaeroid and mercury sphygmomanometers may be downloaded from the british hypertension society www.bhsoc.org For patients with T2 diabetes, please refer to NICE Guidelines, Inherited Guideline H “Management of Type 2 Diabetes: Management of Blood Pressure and Blood Lipids” http://guidance.nice.org.uk/page.aspxo=38564 Return to overview 35
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 and 32: Cardiovascular Risk All patients wi
Page 33: Hypertension Blood pressure should
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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