-
8/2/2019 Becky Allcock - CKD-Chronic Kidney Disease 110907
1/14
CKD-Chronic Kidney Disease
?????????????
Becky Allcock
-
8/2/2019 Becky Allcock - CKD-Chronic Kidney Disease 110907
2/14
What is CKD?
New term for chronic renal failure
Classified into 5 stages according to eGFRStage 1- eGFR >90
Stage 2- eGFR 60-89
Stage 3- eGFR 30-59
Stage 4- eGFR 15-29
Stage 5- eGFR
-
8/2/2019 Becky Allcock - CKD-Chronic Kidney Disease 110907
3/14
Where did all this come from?
Guidelines published by committee on renaldisease, RCP, Renal association and RCGP
Chronic Kidney disease in adults:UK guidelines for identification,management and referral March 2006
SIGN 97-Feb 2007
NICE guideline in progress-Due Sept 2008
QOF points-CKD is one of the new clinicaldomains
-
8/2/2019 Becky Allcock - CKD-Chronic Kidney Disease 110907
4/14
What is eGFR?
Estimated glomerular filtration rate
More sensitive marker of CHRONIC renal
impairment than creatinine. Similar to creatinine clearance
-
8/2/2019 Becky Allcock - CKD-Chronic Kidney Disease 110907
5/14
How do we calculate it?
Thankfully its done for us in Tayside
MDRD formula 86 x (Creat / 88.4)-1.154 x (Age)-0.203 x (0.742 iffemale) x (1.210 if black).
On-line calculator www.renal.org
Lab result is better measure than
calculation
http://www.renal.org/http://www.renal.org/ -
8/2/2019 Becky Allcock - CKD-Chronic Kidney Disease 110907
6/14
Whats normal?
Trend over time is useful
>90ml/min/1.73m is normal
60-90 does not itself indicate CKD unlessevidence of kidney damage
Tayside gives numerical value up to 60
eGFR
-
8/2/2019 Becky Allcock - CKD-Chronic Kidney Disease 110907
7/14
What do we need to do about alow eGFR?
If unexpected look at historic creatinine-if big change or no historic records repeat in 1 week if well
-if unwell consider acute renal injury rpt test and discuss with specialist
Check patients blood pressure-target BP is 130/85, if there is proteinuria a lower target is recommended 120/75
-QOF target is 140/85
-Treat with ACEI OR ARB (angiotensin II receptor blockers)
-Check potassium before and after two weeks and after dose change
-If someone is well controlled on other agents and no proteinuria do notchange jut because CKD3
-If BP >150/90 and on three antihypertensives should be referred to appropriate
specialist
-
8/2/2019 Becky Allcock - CKD-Chronic Kidney Disease 110907
8/14
What do we need to do about alow eGFR?
Test for proteinuria-urine dip-stick annually, change in BP, oedema or systemic disease is
an indication for dip-stick testing
-consider infection
-if positive dip stick send white topped plain bottle to lab for total
protein:creatinine ratio (TPCR)
-Normal TPCR is 45mg/mmol is considered proteinuria
-Check for anaemia Hb
-
8/2/2019 Becky Allcock - CKD-Chronic Kidney Disease 110907
9/14
What do we need to do about alow eGFR?
Manage other cardiovascular risk
Improve control of heart failure and diabetes
Medication review of drugs which impair renalfunction
In men consider prostatic disease causingoutflow obstruction
Asses stability of disease (by monitoringcreatinine every 6-12 months)
Identify those that need referral to nephrology
-
8/2/2019 Becky Allcock - CKD-Chronic Kidney Disease 110907
10/14
Who requires referral tonephrology?
A Summary-further guidance www.renal.org-Those with acute renal failure-Those with significant proteinuria (>1g/day)
equivalent to protien:creatinine ratio of100mg/mmol
-Microscopic haematuria (may need urologyreferral first)
-All stage 5 (stage 4 should be discussed)-Those with functional consequence of CKD eg-
anaemia, bone disease, refractory hypertension
http://www.renal.org/http://www.renal.org/ -
8/2/2019 Becky Allcock - CKD-Chronic Kidney Disease 110907
11/14
What info is required for referral?
Dates and results of previous serum creatinine Serum potassium Haemoglobin
Past medical history and full drug history Blood pressure Dipstick result and total protein:creatinine ratio if more
than trace of protein present ?Renal u/s-local policy
If diabetic HbA1c Details of prostate disease Some may not be appropriate for referral
-
8/2/2019 Becky Allcock - CKD-Chronic Kidney Disease 110907
12/14
How often to measure eGFR
Annually in at risk groups
Stage: 1 and 2 (only diagnosed if renal
impairment)-annually Stage 3: 6/12 on diagnosis, annually when
stable
Stage 4: 3/12 on diagnosis, six monthlywhen stable
Stage 5: Three monthly
-
8/2/2019 Becky Allcock - CKD-Chronic Kidney Disease 110907
13/14
What QOF points are available?
Practice needs to produce a register of patientsover 18 years of age with CKD 3-5. (6 points)
Percentage of those on the register who have a
recorded BP in last 15 months (6 points) Percentage of patients on the register in whom
last BP reading in last 15 months is
-
8/2/2019 Becky Allcock - CKD-Chronic Kidney Disease 110907
14/14
References
CKD Frequently asked questions. April2007
www.renal.org Chronic Kidney disease in adults:UK
guidelines for identification, managementand referral March 2006
www.bma.org.uk/ap.nsf/content/gof06
www.opsi.gov.uk
http://www.renal.org/http://www.bma.org.uk/ap.nsf/content/gof06http://www.opsi.gov.uk/http://www.opsi.gov.uk/http://www.bma.org.uk/ap.nsf/content/gof06http://www.renal.org/