N Identification and investigation of people who have or are at risk of developing CKD n Classification of CKD and identification. Stage 4 CKD is defined by a glomerular filtration rate.
Everything NICE has said on chronic kidney disease renal failure in an interactive flowchart.
Ckd classification nice. CKD is classified according to estimated GFR eGFR and albumincreatinine ratio ACR see table 1 using G to denote the GFR category G1G5 which have the same GFR thresholds as the CKD stages 15 recommended previously and A for the ACR category A1A3 for example. The National service framework for renal services adopted the US National Kidney Foundation kidney disease outcomes quality initiative NKF-KDOQI classification of CKD. Follow the treatment recommendations in Hypertension NICE clinical guideline 127 for people with CKD hypertension and an ACR of less than 30 mgmmol ACR categories A1 and A2 if they do not have diabetes.
There is some stuff that as similar in this to previous guidelines but a fair bit that is different. Management of chronic kidney disease CKD in adults in primary and secondary care has been updated using new available evidence NICE 2014. CKD is classified based on the eGFR and the level of proteinuria and helps to risk stratify patients.
New information in the guidance focuses on. Specifically the persistent and serious criticism that successive iterations of the CKD classification systems including those promulgated in 2013 by the Kidney Disease. The recommendations on monitoring for anaemia are based on the NICE guidelines on CKD NICE 2015a and anaemia in CKD NICE 2015b and the KDIGO Anemia Work Group publication which recommends testing for anaemia at least annually in people with CKD stage 3 without anaemia and more frequently for people with CKD stages 45 who should be under specialist care KDIGO 2012a.
To delineate an increased risk of adverse outcomes the 2008 NICE guideline on chronic kidney disease suggested 2 key changes to this classification. I have highlighted the main differences and why they have been made then included a flow chart which covers the main features of management then summarised some of the other important bits to be aware of. CKD describes abnormal kidney function andor structure.
If risk factors for CKD repeat eGFR in 12 months eGFR 60 and ACR 30-69 See Box 2 Management in Primary Care Stages 3A 3B eGFR 30 and 60 ACR 30 – 69 No haematuria See Box 2 Management in Primary Care. Classification of chronic kidney disease using GFR and ACR categories GFR and ACR categories and risk of adverse outcomes ACR categories mgmmol description and range 30 Severely increased A1 A2 A3 m 2 e 90 Normal and high G1 No CKD in the absence of markers of kidney damage 6089 Mild reduction. This classification divides CKD into 5 stages according to the extent of a persons loss of renal function.
Chronic kidney disease is classified using a combination of GFR and albumincreatinine ratio ACR. Classification of CKD. The following lists all the pages in the guide.
Revised August 2017 The aim is to provide quick online support for the diagnosis and management of chronic kidney disease in the community and elsewhere. Determining the cause of CKD distinguishes whether the patient has a systemic condition or a localized condition in the kidney such as glomerular disease because this functionality affects management. A person with an eGFR of 25 mlmin173 m2 and an ACR of 15 mgmmol has CKD G4A2.
Assessment and management CG182 NICE 2014. Improving Global Outcome KDIGO CKD Work Group 2 and in 2014 by NICE UK National Institute of Health and Care Excellence 3 have not incorporated an age-based approach to diagnosis and classifications of CKD. A decreased GFR and an increased ACR is associated with an increased risk of adverse outcomes.
This is the updated guideline from NICE which looks at CKD. Cause of CKD is classified based on presence or absence of systemic disease and the location within the kidney of observed or presumed pathologic-anatomic findings on kidney biopsy or imaging. The UK eCKD Guide is derived from the NICE SIGN and Renal Association guidelines.
Last modified March 2015 Page 4 of 62. Patients are classified as G1-G5 based on the eGFR and A1-A3 based on the ACR albumincreatinine ratio as detailed below. CKD is classified based on the underlying cause GFR and proteinuria category.
Chronic Kidney Disease CKD Algorithm Page 5 Management Stages 1 2 eGFR 60 and ACR 30 If no other risk factors for CKD consider normal. There are multiple possible causes and risk factors for CKD and its progression including hypertension diabetes mellitus cardiovascular disease CVD acute kidney injury AKI nephrotoxic drugs and obstructive uropathy. For example a person with an eGFR of 25 mlmin173 m 2 and an ACR of 15 mgmmol has a CKD classification of G4A2.
The subdivision of stage 3 into 3a GFR Chronic kidney disease in adults. Early detection of people with CKD is important so that treatment can be initiated to prevent or delay kidney disease progression reduce or prevent the development of. Chronic kidney disease CKD is a common condition associated with significant amenable morbidity and mortality primarily related to the substantially increased risk of cardiovascular disease CVD in this population.
This NICE Pathway covers the early identification and management of chronic kidney disease in adults in primary and secondary care.