Chronic Kidney Disease Pathway Document Description Presented ...

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Follow-up Suggested follow-up plan Stage Description Frequency 3 eGFR 30 – 59 mls/min 6 monthly (12 monthly if stable*) 4 eGFR 15 – 29 mls/min 3 monthly (6 monthly if stable*) 5 eGFR < 15 mls/min 6 weekly *Stability = < 5mls/min fall in eGFR over 12 months Take the following steps to identify progressive CKD: • Obtain a minimum of three eGFR estimations over a period of not less than 90 days. • Define progression as a decline in eGFR of > 5 ml/min/1.73 m 2 within 1 year, or > 10 ml/min/1.73 m 2 within 5 years. • Focus particularly on those in whom a decline of eGFR continuing at the observed rate would lead to the need for renal replacement therapy within their lifetime (eGFR
Stage 3 Management at stage 3 should include all of the interventions as detailed for stages 1 and 2 plus the following section/s for stage 3. Management of Anaemia Lower levels of kidney function have been proven to be associated with lower haemoglobin levels and a higher prevalence and severity of anaemia.This is especially true in patients with diabetes and CKD. Anaemia can occur early in the course of diabetic kidney disease and is associated with inappropriately low erythropoietin concentrations 1 . In patients with chronic renal disease, normochromic normocytic anaemia may develop from decreased renal synthesis of erythropoietin. The anaemia becomes more severe as the GFR decreases 2 . No reticulocyte response occurs, red blood cell survival is decreased, and there is an associated increased bleeding tendency due to uraemia-induced platelet dysfunction. An eGFR of less than 60 ml/min (stage 3 onwards) should trigger investigation into whether anaemia is due to CKD. When the eGFR is greater than or equal to 60 ml/min (stage 1 and 2) anaemia is more likely to be related to other causes 3 . All patients at stage 3 CKD should have an annual measurement of haemoglobin (Hb) If the Hb is < 11 g/dl Not all anaemia in patients with CKD will be ‘renal anaemia’ and causes of anaemia other than CKD should be actively excluded before a diagnosis of anaemia associated with CKD can be made 3 . Other causes: • Chronic blood loss • Iron deficiency • Vitamin B 12 or folate deficiency • Hypothyroidism • Chronic infection or inflammation • Hyperparathyroidism (consider referral for assessment) • Aluminum toxicity 51
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 and 48: References Audit Commission (2002)
Page 49: Influenza and Pneumococcal Vaccine
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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