Chronic Kidney Disease Pathway Document Description Presented ...

Stage 5
Patients identified at CKD stage 5 should be referred urgently for
specialist management unless they are already known to the nephrology
dept. Shared management plans should be agreed between primary and
secondary care, especially for patients who chose to be treated
conservatively and for those who are being worked up for renal
replacement therapy.
Exceptions to Referral
• Patients with deteriorating kidney function as a consequence of another
terminal illness
• Patients for whom further investigation and management is clearly
inappropriate
• Patients with stable function with all appropriate investigations and
interventions completed who have agreed and understood their individual
care pathway.
Shared care management should include:
• 3 monthly follow-up where serum creatinine, eGFR, Hb, calcium, phosphate,
PTH are monitored and acted upon including correction of acidosis.
• Dietary assessment and advice/referral
• Hepatitis B immunisation
• Information and support for patient and family in treatment options
• Timely provision of renal replacement therapy depending on patient choice
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