Chronic Kidney Disease Pathway Document Description Presented ...

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Immunisation Against Hepatitis B National Guidelines: “Immunisation against HBV is recommended for patients on dialysis or in transplantation programmes. Patients with chronic renal failure should be immunised as soon as it is anticipated that they may require dialysis or transplantation. Vaccine and, if appropriate, hepatitis B immunoglobulin should be given to susceptible patients who have been exposed to HBV.” Department of Health Good Practice Guidelines for Renal Dialysis/Transplantation Units 2002 Prevention and Control of Blood-borne Virus Infection “Patients with CKD in whom dialysis is anticipated, should be screened for hepatitis B and C as well as HIV infection. Patients who are hepatitis B surface antigen and hepatitis B surface antibody negative should be immunised and their antibody levels measured post vaccination.” UK Renal Association Clinical Practice Guidelines 4th Edition 2007 Clinical Practice Guidelines for the Care of Patients with Chronic Kidney Disease Immunisation Programme • Use standard course (0, 1, 6 months) and titre level taken 6 weeks after last dose • Recommended dose 40mcg • Intramuscularly in the upper arm Return to overview 48
Influenza and Pneumococcal Vaccine All patients with CKD should be advised to have an influenza vaccine by the practice at the appropriate time each year. Efforts should be made to target the patients who appear on the CKD register. Pnuemococcal vaccine should also be offered to patients who remain unimmunised. This may be given at the same time as the influenza vaccine, but patients who have not received pneumococcal vaccine may be immunised at any time during the year. Contraindications, criteria and schedule for the flu and pneumococcal vaccine and can be found in product literature and in the British National Formulary • Influenza - http://www.bnf.org/bnf/bnf/current/6509.htm • Pneumococcal - http://www.bnf.org/bnf/bnf/current/6490.htm Guidelines for administration of the flu vaccine can be found in the “green book”, “Immunisation Against Infectious Diseases”. Return to overview 49
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 and 44: Lower levels of proteinuria should
Page 45 and 46: Glycaemic Control CKD and Diabetes
Page 47: References Audit Commission (2002)
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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