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CHRONIC KIDNEY DISEASE (CKD)
CKD is a long-term condition in which waste products normally removed by the kidneys remain in the blood. A person with CKD is at increased risk of heart attack or stroke, especially if they smoke or are overweight. CKD affects about 1 in 10 of the UK population, and at age ≥75 years 1 in 2 because of normal ageing of kidneys. Fewer than 1 in 10 people with CKD ever require dialysis or a kidney transplant, but people with CKD should have regular checks of kidney function and blood pressure. In the UK, CKD is most often caused by diabetes (CKD is a common complication of diabetes), uncontrolled or poorly treated hypertension, or an age-related decline in kidney function. There are other less common causes. The focus of primary care management is cardiovascular risk reduction. Control of blood pressure, especially in individuals with proteinuria, reduces cardiovascular risk and slows progression of kidney disease, delaying the need for dialysis or transplantation.
NICE QS5 Chronic kidney disease; 2011 (Updated 2017) https://guidance.nice.org.uk/QS5
NICE CG182 Chronic kidney disease in adults: assessment and management; 2014 (Updated 2015, update expected August 2021) https://www.nice.org.uk/guidance/cg182
Renal Association. UK eCKD Guide; 2017 https://renal.org/health-professionals/information-resources/uk-eckd-guide
Patient UK. Chronic Kidney Disease, Professional reference; 2014 https://patient.info/doctor/chronic-kidney-disease-pro
Patient UK. Chronic Kidney Disease, information for patients https://patient.info/kidney-urinary-tract/chronic-kidney-disease-leaflet
UK National Kidney Federation https://www.kidney.org.uk
Identifying and monitoring CKD
Declining kidney function is identified and quantified by 'estimated glomerular filtration rate' (eGFR). Monitoring is by a combination of: a) eGFR b) urine albumin:creatinine ratio (ACR), to detect proteinuria.
Screening for CKD
NICE recommends screening for CKD (using eGFR and ACR) in people at risk because of:
CKD prevalence increases with age, and it is more common in females and some ethnic groups, but do not screen for CKD on the basis of age, sex or ethnicity alone. eGFR reporting has identified many people with CKD, most of whom are asymptomatic. Only a few will progress to end-stage renal disease, but all are at increased risk of CVD. Practical tips on measuring kidney function (NICE CG73)
Practical tips for measuring proteinuria
Every patient with CKD should be reviewed at least annually, depending on their condition, with recent blood results, urine test and BP reading, to:
Be aware of QOF indicators, and ensure correct application of Read codes.
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