Becky Allcock - CKD-Chronic Kidney Disease 110907

8/2/2019 Becky Allcock - CKD-Chronic Kidney Disease 110907

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CKD-Chronic Kidney Disease

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Becky Allcock


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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


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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


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What is eGFR?

Estimated glomerular filtration rate

More sensitive marker of CHRONIC renal

impairment than creatinine. Similar to creatinine clearance


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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/


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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


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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


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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


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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


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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/


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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


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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


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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


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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/

Becky Allcock - CKD-Chronic Kidney Disease 110907

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