Chronic Kidney Disease Pathway Document Description Presented ...

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Influenza/Pneumococcal Vaccination ……………………….. 49 Follow-up ……………………………………………………….. 50 Stage 3 …………………………………………………………………………… 51 Anaemia ……………………………………………………….. 51 Stage 4 …………………………………………………………………………… 54 One-Stop Renal Clinic ………………………………………. 54 Bone Metabolism …………………………………………….. 56 Annual Review ……………………………………………….. 57 Stage 5 ………………………………………………………………………….. 59 Referral ……………………………………………………….. 60 Renal Ultrasound ……………………………………………. 61 Abbreviations …………………………………………………………………… 62 Appendix 1: Calcium and Phosphate Balance pathway …………………………………. 63 6
Introduction <strong>Chronic</strong> kidney disease (CKD) describes abnormal kidney function and/or structure. It is common, frequently unrecognised and often exists together with other conditions (for example, cardiovascular disease and diabetes). When advanced, it also carries a higher risk of mortality. The risk of developing CKD increases with increasing age, and some conditions that coexist with CKD become more severe as kidney dysfunction advances. CKD can progress to established renal failure in a small but significant percentage of people. CKD is usually asymptomatic, but it is detectable, and tests for detecting CKD are both simple and freely available. There is evidence that treatment can prevent or delay the progression of CKD, reduce or prevent the development of complications and reduce the risk of cardiovascular disease. However, because of a lack of specific symptoms, people with CKD are often not diagnosed, or diagnosed late when CKD is at an advanced stage. http://www.nice.org.uk/nicemedia/pdf/CG073NICEGuideline.pdf Normal <strong>Kidney</strong> Ageing A normal estimated glomerular filtration rate (eGFR) is about 100 ml/min in young adults. However, this may be somewhat lower, some young adults with normal kidneys may have an eGFR as low as 75 ml/min. Normal kidney function deteriorates with age and falls by about 1 ml/min per year. Therefore as people get older, many healthy people aged 75+ may have an eGFR of < 60 ml/min. Recent research suggests that 1 in 10 of the population may have chronic kidney disease (CKD), but it is less common in young adults, being present in 1 in 50 people. In those aged over 75 years, CKD is present in 1 out of 2 people. However, many elderly people with an eGFR < 60 mls/min may not have ‘diseased’ kidneys, but have normal ageing of their kidneys. Although severe kidney failure will not occur with normal ageing of the kidneys, there is an increased chance of high blood pressure and heart disease or stroke. It is recommended that all patients with CKD stage 1 – 5, including elderly patients are added to the CKD register for the GMS Contract Quality and Outcomes Framework and undergo annual screening to monitor the rate of progression, blood pressure, proteinuria and development of associated cardiovascular risk factors. http://www.kidney.org.uk/Medical-Info/ckd-info/index.html Late referral of patients with CKD requiring renal replacement therapy (RRT) to specialist renal services is associated with significant cost and poor clinical outcomes. On average 30% of people with advanced kidney disease are referred late to nephrology services from both primary and secondary care, causing increased mortality and morbidity. http://www.nice.org.uk/nicemedia/pdf/CG073NICEGuideline.pdf 7
Page 1 and 2: Chronic Kidney Disease Pathway Docu
Page 3 and 4: Pathway for the Identification and
Page 5: Contents Introduction …………
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 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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