Chronic Kidney Disease Pathway Document Description Presented ...

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Contact details: Clinic co-ordinator Lead Clinician Renal Administrative Secretary Tel. 01384 244432, Fax. 01384 244543 Claire.miles@dgoh.nhs Senior Consultant Renal Physician Tel. 01384 244432, Fax. 01384 244543 Claire.miles@dgoh.nhs Consultants Tel. 01384 244432, Fax. 01384 244543 Claire.miles@dgoh.nhs Renal Dieticians Tel. 01384 244017, Fax. 01384 244017 Christine.morgan@dgoh.nhs Radiology Support Tel. 01384 456111 ext. 2541 Peter.oliver@dgoh.nhs Out-Patient Manager Tel. 01384 456111 ext. 2406 Rose.tonty@dgoh.nhs Return to overview Bone Metabolism Patients at stage 4 and 5 should have regular calcium, phosphate and parathyroid hormone (PTH) concentrations measured. Specimens need to be in path lab within 1 hour. Therefore it would be recommended that the specimens are taken at the phlebotomy clinic at Russells Hall Hospital. Blood requests should include: • Calcium phosphate • PTH • Bicarbonate (in selected patients) • Serum calcium and phosphate plus alkaline phosphatase (in selected patients) • 1,25 dihydroxycholecalciferol (in selected patients) It is recommended that the management of bone metabolism is carried out by specialist nephrologist, unless practices are confident to do so under advice from the nephrology dept. Investigations into bone metabolism are included in the one-stop clinic assessment and in the shared management plan with primary care. 56
Where vitamin D supplementation is indicated: Stage 1 – 3A Initiate alfacalcidol 0.25mcg alternate days and titrate according to PTH and serum calcium and phosphate. Consider adcal / calcichew D3 1 twice daily in patients at risk of osteoporosis. Stage 3B - 5 Initiate alfacalcidol, dose titrated according to PTH, serum calcium and phosphate and continue to monitor calcium and phosphate levels See Appendix 1 - Pathway for the Management of Calcium and Phosphate Balance in Chronic Kidney Disease Osteoporosis – initiate biphosphonates in stages 1 – 3B Dudley PCT formulary drug of choice - Alendronate 70mg weekly N.B. Avoid if eGFR
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 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: Clinic inclusion criteria: Patients
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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