Chronic Kidney Disease Pathway Document Description Presented ...

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Diet in CKD Information on nutritional recommendations can be found on EdREN, the website of the Renal Unit of the Royal Infirmary of Edinburgh. http://renux.dmed.ed.ac.uk/EdREN/EdRenINFObits/Diet_CRF.html Summary of Downloads Keeping salt intake down Cutting Down Potassium A short leaflet about Fluid Controlling phosphate Increasing your calorie intake Weight control Renal Diets for Christmas and other holidays Return to overview 44
Glycaemic Control CKD and Diabetes Diabetes mellitus is the most common cause of chronic kidney disease worldwide (Burrows-Hudson 2005) (Levy et al 2006) and at least 20-30% of people with diabetes will have some evidence of the disease (Audit Commission 2002). There is a variation in the incidence of diabetes among racial and ethnic groups, with people of South Asian, African and African-Caribbean descent having a higher than average risk of type 2 diabetes (DOH 2001). The risk of nephropathy is related to the duration of diabetes with microalbuminuria being the first sign, progressing to albuminuria then nephropathy. The presence of urine albumin whether microalbuminuria or albuminuria strongly increases the person’s cardiovascular risk (University Hospital of Leicester 2006). Thereby a person with diabetes should not be assessed in isolation for kidney disease but also for lipid lowering, anti-platelet therapy and hypertension in tandem. Optimal glycaemic control should be the cornerstone of all treatment for diabetes care. For guidance please see Dudley Diabetes Management Guidelines for Adults 2006. Persistent hyperglycaemia results in the thickening of the basement membranes and accumulation of proteins in the glomeruli (Levy et al 2006). Research studies suggest that intensive glycaemic control can reduce the rate of microalbuminuria, proteinuria and nephropathy (Gross et al 2005) and improvement in glycaemic control may reduce the risk of patients with diabetes developing both macrovascular and microvascular complications (DOH 2001). Studies relating to hypertension control also suggest similar results in relation to prevention of renal failure (DOH 2001) recommending the use of ACE inhibitors (Angiotension Converting Enzyme Inhibitors) or ARBs (Angiotension Receptor Blockers) to delay the onset of diabetic nephropathy in people with microalbuminuria. 45
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 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: Lower levels of proteinuria should
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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