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Transcript of CKD Early Identification
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Chronic kidney disease
Early identification and management of chronic
kidney disease in adults in primary and secondary
care
!: > 2008
NICE clinical guideline 73
.../73
&!CE J C C== &!CE
=. A = 5 J > > 2009 = =
A= 2007 &!CE' ' = >=' (2007,
2009). > H HHH.../
L &!CE 2008
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Contents
! ................................................................................................................................ 4
- ................................................................................................................... 6
#J >=> ............................................................................................... 7
1 G ................................................................................................................................ 10
1.1 ! ................................................................................................................................... 10
1.2 C= .................................................................................................................................. 14
1.3 !> ............................................................................................................... 15
1.4 ! = = ...................................................................................................... 16
1.5 .................................................................................................................................... 17
1.6 *= ................................................................................................................................ 18
1.7 $J= ............................................................................................................................... 19
1.8 >J ........................................................................................................................... 19
1.9 >= ....................................................................................................................... 22
2 & ........................................................................................ 25
3 !>=> ....................................................................................................................... 26
4 * >> ................................................................................................... 27
4.1 > J ..................................................................................................... 27
4.2 C= = H C#D ......................................................................................... 27
4.3 ACE /A*B J =H == .................................................................. 28
4.4 D > C#D? .............................................................................................. 28
4.5 = > C#D = .................................................... 29
5 = ............................................................................................... 30
5.1 F== = ................................................................................................................................... 30
5.2 !> =................................................................................................................. 30
6 *= &!CE ........................................................................................................... 31
C J &!CE == = 73
L &!CE 2008. A== . $ > > 2008 2 39
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7 =............................................................................................................. 32
AI A: G= D=> G ....................................................................... 33
&= C== C C C .......................................................................... 35
AI B: G= *H =.................................................................................. 36
AI C: =>....................................................................................................... 37
A = .................................................................................................................... 38
C J &!CE == = 73
L &!CE 2008. A== . $ > > 2008 3 39
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Introduction
C J (C#D) >= J / . !
>>, =J I H ( I>=,
= ). , = >=J.
= C#D H , > I H
C#D > > J J . C#D =
= = >== =.
C#D ==J J>>. B =, C#D >=
=J ==. > =J
C#D, => >= =
. H, = J>> = H C#D
, = H C#D .
'&= >H = ' '&= #J F
J > =J ' (F-#D!) = C#D. =
C#D . 3O5 >J J =>= = (GF*)
=, H 1 2 = , =>
>, = >=.
30% = H J = =J
> >J J , >=J >J.
2% = & = => J (=J =)
H = = =.
> = (H =)
= = = ==J . == = J J:
= H = C#D
H >> = H
=
H H== = J / >= J
H J >
C J &!CE == = 73
L &!CE 2008. A== . $ > > 2008 4 39
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H = = J .
C J &!CE == = 73
L &!CE 2008. A== . $ > > 2008 5 39
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Person-centred care
= = H J .
> = =' . = H
J = J > >
>, H = =. ! = H
J > , = = = ==H
D> =' > =
CJ A. ! =, = = = ==H > =
G>.
G >> H = = =. ! =
J - H > = ' . >
, > = , = ===J . ! =
= = = H = J=, J =
=, = H E=.
! , >= = J =
> . F>= = = > J .
C J &!CE == = 73
L &!CE 2008. A== . $ > > 2008 6 39
https://www.gov.uk/government/publications/reference-guide-to-consent-for-examination-or-treatment-second-editionhttp://www.justice.gov.uk/protecting-the-vulnerable/mental-capacity-acthttp://www.justice.gov.uk/protecting-the-vulnerable/mental-capacity-acthttp://www.wales.nhs.uk/consenthttp://www.wales.nhs.uk/consenthttp://www.wales.nhs.uk/consenthttp://www.wales.nhs.uk/consenthttp://www.justice.gov.uk/protecting-the-vulnerable/mental-capacity-acthttp://www.justice.gov.uk/protecting-the-vulnerable/mental-capacity-acthttps://www.gov.uk/government/publications/reference-guide-to-consent-for-examination-or-treatment-second-edition -
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Key priorities for implementation
J , =>: (AC*) ,
J : (C*) =H == . F
> , C* =. AC*
>> > = H .
- KJ> (ACE )/ -!!
= (A*B) - = H C#D J AC* 30 >/>>=
> (I>=J = C* 50 >/>>= >, J I
0.5 /24 >)1.
3 C#D = = H J:
GF* 45O59 >=/>/1.73 >2 ( 3A)
GF* 30O44 >=/>/1.73 >2 ( 3B).
Stages of chronic kidney disease (updated)
Stagea GFR (ml/min/
1.73 m2)
Description
1 90 > &>= GF*, H J
>
2 60O89 = GF*, H J >
3A 45O59
3B 30O44
GF*, H H
J >
4 15O29 GF*, H H
J >
5 < 15 E= = =
I () H C#D
(>> 1.2.1).
C J &!CE == = 73
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= H C#D ==H = >==J =
>:
4 5 C#D (H H )
== (AC* 70 >/>>= >, I>=J =
C* 100 >/>>= >, J I 1 /24 >) =
H =J =J
(AC* 30 >/>>= >, I>=J = C* 50 >/>>=
>, J I 0.5 /24 >) H >
=J = > GF* (GF*) (> 5 >=/>/1.73 >2 1 J,
> 10 >=/>/1.73 >2 H 5 J)
J > =J == =
J ( 'J: >>
J = >J ' &!CE == = 34)
= H, , C#D
= J .
= C#D J J ==H :
J
= (> , =, =
= = = )
= = , = == JJ
>=J> H = J => O I>=, J> =
J>
>=J J 5 C#D J J
> .
==H J C#D.
C J &!CE == = 73
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>>> GF* > = 90 J.
! = H H GF*, GF* H 2 H
I= GF* O I>=, J ;J ACE /A*B J.
D = GF* > 5 >=/>/1.73 >2 H 1 J,
> 10 >=/>/1.73 >2 H 5 J.
F ==J H> = GF*
H= = = => J H => J
I= =.
! = H C#D > J= = =H 140 >> (
120O139 >>) = = =H 90 >>2.
1 H AC* = = ACE >
= H C#D . = ACE I =J
= J, >, =H
= =. ==H =J ==
G= D=> G (GDG) ==I H== H .
2 GDG = =,
= = C#D. ==
= = J =H = , >
I. EI J = &!CE J = (&!CE ==
= 34) ; => = =
=. GDG = ,
>>, H == I H== > C#D.
C J &!CE == = 73
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1 Guidance
==H == . == = =
> = .
1.1 Investigation
Measurement of kidney function
1.1.1 > >> >, ==
= = > GF* (GF*)
( >> 1.1.2) >
=3.
1.1.2 !D ( = > >J)-= >= D*D
(> = ) > GF*,
J H = =
>=. !==J J K
> H !D ( I>=, KJ> J). -
J ( I>=, " J), >=J J-
;> >> H-=J (
I>=, J = I= =J > >).
1.1.3 , =J J GF* =
(>==J GF* J 1.21 A-C J4).
1.1.4 ! = GF* 60 >=/>/1.73 >2 > H ,
> > GF* > = GF*.
1.1.5 GF* >=J 60 >=/>/1.73 >2 >,
> > 20%
= .
1.1.6 =J > GF* O I>=,
> >J = = =
C J &!CE == = 73
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= O = > (=, 51C-EDA, 125!-
=> I=).
1.1.7 ! H I> >= > O I>=,
J=, > = H >= H O
GF* H . (* >= > H== = >
>= > > GF*.)
1.1.8 A = J > 12 =
GF* >. A =J = >=
J J =J H 12
.
1.1.9 A GF* = = 60 >=/>/1.73 >2 =J
= > J H 2 H. ==H
== =J= =J > (M 5%) H
GF*.
Measurement of eGFR: how often? a
A==J == .
D == =J == H C#D.
EI J = == . J
>J H GF* == > J = H==
.
GF* (>=/>/1.73 >2) J= J
1 2 N 60 + J 12 >=J
3A 3B 30O59 6 >=J
4 15O29 3 >=J
5 = GDG .
Proteinuria
C J &!CE == = 73
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A=> = > =>= . *
== >=J =>, = , ==J .
AC* J C* =H ==
=J C#D. H, >J == =
=J C* J > == .
1.1.10 D J = J =
==J > => =H I =
AC*.
1.1.11 J , AC* ,
J C* =H == . F > , C* =. AC*
>> > = H .
1.1.12 F = , AC* 30 >/>>= > (
I>=J = C* 50 >/>>= >, J
I 0.5 /24 >) = 70 >/>>= (I>=J
= C* = 100 >/>>=, J I =
1 /24 ) = > J =J >>=. ! = AC* 70 >/>>= >, C* 100 >/>>=
>, >= .
1.1.13 ! = H ===J
H AC* 30 >/>>= > ( I>=J
= C* 50 >/>>= >, J I 0.5 /
24 >).
1.1.14 ! = H >=> (AC* > 2.5 >/
>>= > AC* > 3.5 >/>>= H>) ===J
.
1.1.15 A== = H , = H H GF* = 60
>=/>/1.73 >2, = J =>/ I .
>= = = > =J > >= (
=J ).
C J &!CE == = 73
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1.1.16 J J =J J =>/ I =
H GF* 60 >=/>/1.73 >2 > C#D
( = >> 1.1.22).
Haematuria
1.1.17 >,
>J.
E= = 1+ >.
D >J > =.
1.1.18 = >
> >, H
> = >.
1.1.19 = >, H H , = >
J >=J .
1.1.20 = > = ==H ==J H >, /=>
( >> ), GF* = > =
> .
Early identification
1.1.21 GF* = H I
= =>. C GF* = ==J = =-> J> -= -=>>J (&A!D)
>.
1.1.22 = C#D J J ==H :
J
C J &!CE == = 73
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= (> , =, =
= = = )
= = , = == JJ
>=J> H = J => O I>=, J>
= J>
>=J J 5 C#D J J
> .
1.1.23 ! , , J
> = C#D. ! >= J>,
J, J = >
= C#D.
1.2 Classification
1.2.1 I () H C#D.
1.2.2 F = J AC* 30 >/
>>= >, C* 50 >/>>= > (I>=J =
J I 0.5 /24 >).
1.2.3 3 C#D = = H J:
GF* 45O59 >=/>/1.73 >2 ( 3A)
GF* 30O44 >=/>/1.73 >
2
( 3B).
Stages of chronic kidney disease (updated)
Stagea
GFR (ml/min/
1.73 m2)
Description
1 90 > &>= GF*, H J
>
C J &!CE == = 73
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2 60O89 = GF*, H J >
3A 45O59
3B 30O44
GF*, H H
J >
4 15O29 GF*, H H
J >
5 < 15 E= = =
I () H C#D
(>> 1.2.1).
1.2.4 A J C#D, >> = = ==J J
5.
1.3 Information and education
1.3.1 = H C#D > =
C#D, >= .
1.3.2 = > >>, = = H
C#D => > . ==H .
C#D H =?
= = J H J =?
> == C#D, H
H >= >J =
>/>?
= > = H ?
! H HJ = C#D > =' =J =, = ,
H = , = ==H
==?
C J &!CE == = 73
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H = H ; C#D H J==
==?
, > = => J ( J = > =J > I -
> =) ( =
= ).
C >> >J H .
1.3.3 = H C#D =J > >>
==H > > ==J
> > >.
1.3.4 = = > >>
= J = H= C#D J
== = =.
1.3.5 = = H H = H C#D =
J== H
O I>=, , == =.
1.4 Indications for renal ultrasound
1.4.1 = = == = H C#D H:
C#D (GF* = > 5 >=/>/1.73 >2 H 1 J,
> 10 >=/>/1.73 >
2
H 5 J)
= = >
J>> J
>=J J =JJ J 20
4 5 C#D
J = = J.
C J &!CE == = 73
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1.4.2 A = H >=J J J
>= >= = = =
>.
1.5 Progression
1.5.1 ==H J C#D.
>>> GF* > = 90 J.
! = H H GF*, GF* H 2 H
I= GF* O I>=, J ;J ACE /A*B J.
D = GF* > 5 >=/>/1.73 >2 H 1
J, > 10 >=/>/1.73 >2 H 5 J.
F ==J H> = GF*
H= = = => J H => J
I= =.
1.5.2 H = H C#D >
=. :
=
J
>
= A J
&A!D
J =H .
C J &!CE == = 73
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1.5.3 ! = H C#D &A!D >J H
H = == GF*. EI
H = H C#D H &A!D =
>. GF*, ==J = H =H =
GF* / .
1.6 Referral criteria
1.6.1 = H C#D ==H = >==J
= >:
4 5 C#D (H H )
== (AC* 70 >/>>= >, I>=J =
C* 100 >/>>= >, J I 1 /24 >) =
H =J =J
(AC* 30 >/>>= >, I>=J = C* 50 >/
>>= >, J I 0.5 /24 >) H
>
=J = GF* (> 5 >=/>/1.73 >2 1 J, > 10 >=/
>/1.73 >2 H 5 J)
J > =J == =
J ( 'J: >>
J = >J ' &!CE == = 34)
= H, , C#D
= J .
1.6.2 C >> H = J =, >=
= H >J J H C#D
J =.
1.6.3 = > = ;=J , >J =
==H- = ' G J
C J &!CE == = 73
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= =. ! , = -= =
.
1.6.4 =' H > H
=.
1.6.5 = H C#D = =H = >==J
== , = >= O
I>=, > J=>, >, =
=.
1.7 Lifestyle advice
1.7.1 E = H C#D I, =J H
>.
1.7.2 = H J
= C#D , =J
= = J
, H = =H H -= >=.
1.7.3 J = H I
, = J > >=
.
1.7.4 J = H C#D >,
, , = = H .
1.8 Pharmacotherapy
Blood pressure control
1.8.1 ! = H C#D > J= = =H 140 >>
( 120O139 >>) = = =H
90 >>
6
.
C J &!CE == = 73
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1.8.2 ! = H C#D , = = H AC* 70 >/>>=
> (I>=J = C* 100 >/>>= >, J
I 1 /24 >) > J= =
=H 130 >> ( 120O129 >>) = =
=H 80 >>6.
Choice of antihypertensive agents
1.8.3 >=> = O J> >
H ACE > A*B ACE
=.
1.8.4 ACE /A*B = H AC* > 2.5 >/
>>= (>) > 3.5 >/>>= (H>)
J C#D 7.
1.8.5 ACE /A*B - = H C#D J
AC* 30 >/>>= > (I>=J = C* 50 >/>>=
>, J I 0.5 /24 >)7.
1.8.6 ACE /A*B - = H C#D AC* 70 >/
>>= > (I>=J = C* 100 >/>>= >,
J I 1 /24 >)
J = 7.
1.8.7 - = H C#D J AC* =
30 >/>>= (I>=J = C* = 50 >/>>=,
J I = 0.5 /24 ) J
> &!CE J (&!CE ==
= 34) >= C#D.
1.8.8 ACE /A*B > >I>> =
-= 8.
1.8.9 > , > = H ACE
A*B J > :
C J &!CE == = 73
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>= = ACE /A*B,
> GF* > > =J.
Practicalities of treatment with ACE inhibitors/ARBs
1.8.10 ! = H C#D, > > > >
GF* ACE /A*B J. *
>> H 1 2 H ACE /A*B
J .
1.8.11 ACE /A*B J = >==J >
> > =J >=
(J==J > 5.0 >>=/=).
1.8.12 J=> = ACE /A*B, >,
> H > J=>
= > > .
1.8.13 C H > J=>
ACE /A*B, H > > > > >J .
1.8.14 ACE /A*B J > >
6.0 >>=/= > H > J=>
.
1.8.15 F==H ACE /A*B,
>J GF* > > = = 25% => > = = 30%.
1.8.16 ! == GF* =>
ACE /A*B, = 25% (GF*) 30% (>
) =, = 1O2 H. D
>J ACE /A*B GF* = 25%
=> = 30%.
C J &!CE == = 73
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1.8.17 ! GF* 25% > =>
30% >:
= =>
= > ( I>=, &A!D)
= , ACE
/A*B J =J = =H ,
= J > .
1.8.18 , ACE /A*B = = J
' = =
H .
Statins and antiplatelet drugs
1.8.19 J >J 9 =
(CD)9,10 = H C#D = > = H
C#D = I = = H H
. ! = F>> = =J
> = H C#D.
1.8.20 = H C#D J CD
= = =.
1.8.21 == = H C#D J
CD. C#D =H =
= H > = = H C#D
>== == .
1.8.22 >> =H
= H C#D H J>> J>.
1.9 Other complications
Bone metabolism and osteoporosis
C J &!CE == = 73
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1.9.1 >> =>, , J > ()
> D == = H 1, 2, 3A 3B C#D
>>.
1.9.2 > =>, = H
4 5 C#D (GF* = 30 >=/>/1.73 >2). D>
J J > = ==
>. I = .
1.9.3 >
= H 1, 2, 3A 3B C#D.
1.9.4 > D => = H C#D :
=== == = H 1, 2, 3A 3B C#D
1-=-JIJ=== (===) 1,25-JIJ===
(==) = H 4 5 C#D.
1.9.5 > => =
1-=-JIJ=== 1,25-JIJ====>11.
Anaemia
1.9.6 ! =J >, >= == = H 3B,
4 5 C#D J > ( = 11.0 /=, 'A>
>> = H J ' &!CE == =
39). D> J J > = == >.
3 GF* >J = == ( I>=, = =, J,
> , >= H , > >= =)
H== = ( I>=, A C).
4 ! = = = A J.
C J &!CE == = 73
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5 ! = 70 J, GF* 45O59 >=/>/1.73 >2, = >
H J J >, ==J H C#D-=
>=.
6 GDG = =,
= = C#D. ==
= = J =H = , >
I. EI J = &!CE J = (&!CE ==
= 34) ; => = =
=. GDG = ,
>>, H == I H== > C#D.
7 H AC* = ACE > = H
C#D . = ACE I =J
= J, >, =H =
=. ==H =J ==
GDG == I H== H .
8 >> =
ACE A*B J >= C#D.
9 >=
C#D.
10 >J CD = H C#D = > J
A* J: B C, $J (2003) J = . #J
!= 63: 207O210.
11 D= >> >= C#D J
=. J I > J == = .
C J &!CE == = 73
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2 Notes on the scope of the guidance
&!CE = = H H = H==
H== . = ==.
= =J / = H C#D (=
). ! = H C#D
= = = . ! = = >> C#D = >
J = , J, = .
! = ( 16 J), = = => J,
= H J ;J ( = =) =J =>=,
> C#D, >> J H>
H C#D >> > = H C#D.
How this guideline was developed
&!CE >> &= C== C C C =
=. C = G= D=> G ( I A), H
H = >>. A G= *H= H => = ( I B).
> > H &!CE == = = &!CE
H. A =, 'H &!CE == = =: H =,
= &' ==.
C J &!CE == = 73
L &!CE 2008. A== . $ > > 2008 25 39
http://www.nice.org.uk/guidance/index.jsp?action=download&o=34402http://www.nice.org.uk/HowWeWorkhttp://www.nice.org.uk/aboutnice/howwework/developingniceclinicalguidelines/developing_nice_clinical_guidelines.jsp?domedia=1&mid=62F02D9B-19B9-E0B5-D4A26EC9A934FDC7http://www.nice.org.uk/aboutnice/howwework/developingniceclinicalguidelines/developing_nice_clinical_guidelines.jsp?domedia=1&mid=62F02D9B-19B9-E0B5-D4A26EC9A934FDC7http://www.nice.org.uk/HowWeWorkhttp://www.nice.org.uk/guidance/index.jsp?action=download&o=34402 -
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3 Implementation
= C>> > & >
=>= J D> = ' =',
"=J 2004. !>=> == = > =>=
D2. C C5 J = =
H & = = .
&!CE = = = >=> (= =H).
== H.
= = J > == .
C =:
> = H
>=>
>= > == =.
G , H = == > &!CE,
> = .
A > == .
C J &!CE == = 73
L &!CE 2008. A== . $ > > 2008 26 39
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4 Research recommendations
G= D=> G > ==H >> ,
H , > &!CE .
G= D=> G' == >> = ==
= ( 5).
4.1 Measurement of kidney function
! >> J >
> > J , ==J H GF* 60 >=/>/1.73 >2
>.
Why this is important
> GF* > >
>= > >= J . H, =>
> > J H== H. C
> J =J == >, ==, = >
J . H = > O I>=,
J C O ==J > J . *
H > ==J =J = =J
GF*, >= J, ==J = =H == =J= =J.
4.2 Cardiovascular risk in people with CKD
E > >> = CD
= H C#D = CD == = H C#D.
Why this is important
= H C#D = CD J > ==J >
CD-= J = J =. B >>
= == =J . A= > =
CD J ==J =J =, =
I >= = = H C#D =H. *
C J &!CE == = 73
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=J > >> CD = H C#D
> = J .
4.3 ACE inhibitor/ARB therapy for low levels of proteinuria
=J > H ACE /A*B -
C#D H =H == .
Why this is important
ACE /A*B J = H H >=> ==
== >=> H== =. ! = = ACE /A*B
J = H (AC* 30 >/>>= >, = =
J I 0.5 /24 >) H =. H, J
H H ACE /A*B J = H H =H ==
= =
= =. ! = = ACE /A*B J
= H C#D >J == >= . H==
> == = = : .
4.4 Does age or gender matter in CKD?
F > > > J
== GF* .
Why this is important
C#D =J = H , >= > = H C#D. > ==J
> D*D > GF*, H >
. ==J > >
> = H C#D. = = J ==
GF* .
C J &!CE == = 73
L &!CE 2008. A== . $ > > 2008 28 39
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4.5 Validation of estimating equations in differing CKD
populations
= GF* C A-
C > = =.
Why this is important
D*D >> =J H=J =,
= H = == H C#D. > >
>J = > GF*.
= > == = H C#D, =
D*D J, = =.
C J &!CE == = 73
L &!CE 2008. A== . $ > > 2008 29 39
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5 Other versions of this guideline
5.1 Full guideline
== =, 'C J : =J >> =
>J J ', = > =
=. ! = J &= C== C C C,
== > H.
5.2 Information for the public
&!CE > = I= =.
& =J I > = >
H > >=.
C J &!CE == = 73
L &!CE 2008. A== . $ > > 2008 30 39
http://guidance.nice.org.uk/CG73/Guidance/pdf/Englishhttp://publications.nice.org.uk/IFP73http://publications.nice.org.uk/IFP73http://guidance.nice.org.uk/CG73/Guidance/pdf/English -
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6 Related NICE guidance
$ >: = > > = =
>J J = . &!CE == = 67 (2008).
J 2 : >> J 2 (). &!CE == = 66 (2008).
A> >> = H J . &!CE == = 39 (2006).
*= J &!CE == = 114
J: >> J = >J . &!CE == = 34
(= &!CE == = 18) (2006).
B = > >J . &!CE
= = 1 (2006).
J 2 : >> J 2 . &!CE == = 87 (2009).
C J &!CE == = 73
L &!CE 2008. A== . $ > > 2008 31 39
http://www.nice.org.uk/CG067http://www.nice.org.uk/CG066http://www.nice.org.uk/CG114http://www.nice.org.uk/CG034http://www.nice.org.uk/PH001http://www.nice.org.uk/PH001http://www.nice.org.uk/CG87http://www.nice.org.uk/CG87http://www.nice.org.uk/PH001http://www.nice.org.uk/PH001http://www.nice.org.uk/CG034http://www.nice.org.uk/CG114http://www.nice.org.uk/CG066http://www.nice.org.uk/CG067 -
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7 Updating the guideline
&!CE == = >>
> H >. H 2 4 J =,
H == = = . ! > H =
>, H >J > > >>.
C J &!CE == = 73
L &!CE 2008. A== . $ > > 2008 32 39
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Dr Shelagh O'Riordan
C= G, # CJ =
Professor Paul Roderick
* = =, J >
Dr David Stephens
G= , #
The following individuals were not full members of the Guideline Development Group but were
invited to attend specific meetings.
Dr Claire Beeson
C= G, E # =, J = =
'*
Dr Indranil Dasgupta
C= &=, B>> = =, = 'J 2
' G= D=> G
Dr Patrick Fitzgerald
G= , J = ! B
Dr Neil Iggo
C= &=, *J= I CJ =, J =
$H G=
Dr Kanchana Imrapur
G= , J = D
Dr Marta Lapsley
C== B>, E> = J =, J =
E> $>
C J &!CE == = 73
L &!CE 2008. A== . $ > > 2008 34 39
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Ms Nicola Thomas
$, B=>H = & HJ, J
= & !J
National Collaborating Centre for Chronic Conditions
Ms Lina Bakhshi
!>
Dr Emily Crowe
= * F==H G= D=>
Mr Robert Grant
= A
Dr Suffiya Omarjee (from August 2007 until March 2008)
= E>
Ms Jaim Sutton (until March 2008)
;
Ms Meiyin Tok (until August 2007)
= E>
Mr David Wonderling
= E>
C J &!CE == = 73
L &!CE 2008. A== . $ > > 2008 35 39
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Appendix B: The Guideline Review Panel
G= *H = = =>
= =J > &!CE = =>
. ! =, = = >> =J
. = = >> > ==H :
>J , J , =J, = = J.
Dr Robert Walker (Chair)
G= , C>
Dr Mark Hill
= A, & >= #
Dr John Harley
C== G $, & C
Ailsa Donnelly
$J >>
C J &!CE == = 73
L &!CE 2008. A== . $ > > 2008 36 39
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Appendix C: The algorithms
>> > = &!CE HJ. ==
= = HJ =>.
C J &!CE == = 73
L &!CE 2008. A== . $ > > 2008 37 39
http://pathways.nice.org.uk/pathways/chronic-kidney-diseasehttp://guidance.nice.org.uk/CG73/Guidance/pdf/Englishhttp://guidance.nice.org.uk/CG73/Guidance/pdf/Englishhttp://guidance.nice.org.uk/CG73/Guidance/pdf/Englishhttp://guidance.nice.org.uk/CG73/Guidance/pdf/Englishhttp://pathways.nice.org.uk/pathways/chronic-kidney-disease -
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> =J J. & =
HJ H= H >= H .
Copyright
L &= ! = C== EI== 2008. A== . &!CE J
>= H= J, >J
= -- . & J >>= ,
>>= , ==H H H > &!CE.
Contact NICE
&= ! = C== EI==
$= 1A, CJ H, ==J =K, 1 4B
HHH...
@..
0845 003 7780
C J &!CE == = 73
http://www.nice.org.uk/mailto:[email protected]:[email protected]://www.nice.org.uk/