Chronic Kidney Disease Pathway Document Description Presented ...

Clinic inclusion criteria:
Patients can be referred directly by the GPs (Choose and book or paper
referrals). Patients waiting for conventional appointment may be transferred to
the “one-stop” clinic by the GP or Consultant if appropriate.
The clinic is suitable for:
• Elderly patients
• Those with borderline eGFR where diagnosis may be unclear
• Patients with borderline referral criteria
• A specialist second opinion requested by the GP
• A specific question requested rather than a formal referral
Exclusion criteria
The clinic is not suitable for established and/or advanced renal disease,
which requires many diagnostic tests and long-term follow up.
All patients who attend the “one-stop” clinic are sent a leaflet with their
appointment letter explaining the range of tests they may have, how long the
tests will take and when they can expect results. They are informed that they are
very welcome to bring someone with them. The leaflet also contains contact
numbers for the clinic coordinator should patients wish to access any further
information or alter their appointment time.
Patients benefit by completing their outpatient appointment with a timely and
clear understanding of their diagnosis and management plan rather than
experiencing weeks of uncertainty and apprehension whilst waiting for individual
tests and results. Where immediate treatment is not feasible, the patient will be
given a date for a further appointment before they leave and the referring primary
care clinician informed.
The clinic is currently held at Russells Hall hospital twice monthly with future
plans for further expansion.
For housebound patients this service can be requested as a domiciliary visit from
the Community CKD Team, as an outreach service from Dudley Group of
Hospitals. Portable scanning equipment is available for use by the team. It is
recommended that patients are supported by a member of the primary care
team, usually district nursing services, who meet the CKD team in the patient’s
home. An individual shared care management plan is developed by the CKD
team for use by primary care. Referral is by referral letter to Nephrology Services
at Dudley Group of Hospitals.
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