Chronic Kidney Disease Pathway Document Description Presented ...

Introduction
Chronic 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 Kidney 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
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