Chronic Kidney Disease (CKD) Algorithm - NHS Cumbria

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Box 11 - Anaemia (NCG 114) 5• Check haemoglobin in people witheGFR < 45 ml/min to identify anaemia• Exclude other causes of anaemia• Consider referral for erythropoietin ifhaemoglobin < 10 g/dl• NICE guidance target haemoglobin forpatients on erythropoietin 10 -12 g/dl.Higher haemoglobins may be harmfulBox 12 - Potassium (NCG 73 p14) 1• Repeat if raised• If > 5.5 mmol/l- do not start ACEI/ARB- exclude other factors that causehyperkalaemia & recheck• If > 6.0 mmol/l and other drugs thatpromote hyperkalaemia have beendiscontinued, stop ACEI/ARBs• If > 7.0 mmol/l, repeat test and referurgently• If taking drugs that causehyperkalaemia, more frequentmonitoring of potassium is requiredChronic Kidney Disease (CKD) Algorithm | Page 11
Box 13 - Manage bone conditions(NCG 73 p13) 1• Measure serum calcium and phosphate ifeGFR < 30ml/min• Seek specialist advice if renal bone diseasesuspected• Do not routinely measure serum calcium,phosphate or parathyroid hormone (PTH) ifeGFR > 30ml/min• Offer bisphosphonates for the prevention andtreatment of osteoporosis where appropriatein patients with eGFR > 30ml/min who are atrisk for other reasons (Manufacturers adviseavoid if eGFR 200mg/mmol despite treatment with maximumdose of ACE inhibitor/ARB• Refer to either diabetologist or nephrologistif blood pressure is difficult to controldespite three agentsChronic Kidney Disease (CKD) Algorithm | Page 12
Page 1 and 2: Chronic Kidney Disease(CKD) Algorit
Page 3 and 4: How should it be done?Measure eGFR
Page 5 and 6: ManagementStages 1 & 2Stages 3A & 3
Page 7 and 8: Box 3 -Optimise bloodpressure contr
Page 9 and 10: Evaluate albuminuria and haematuria
Page 11: Box 9 - Renal Ultrasound(NCG 73 p12
Page 15: Key MessagesAll patients with CKD h

Chronic Kidney Disease (CKD) Algorithm - NHS Cumbria

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