The 2014 updated guidance from the National Institute for Health and Care Excellence NICE recommends that GPs reduce overdiagnosis of CKD stage 3a eGFR 4560 mlmin173 m2 by using the renal biomarker cystatin C. If a diagnosis of chronic kidney disease CKD is suspected assess the person for possible associated clinical features.
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 60.
The 2008 NICE. Decreasing estimated glomerular filtration rate eGFR andor increasing proteinuria are independently associated with a poorer prognosis of chronic kidney disease CKD NICE 2015a. Background Creatinine-based estimated glomerular filtration rate eGFR determines chronic kidney disease CKD stage but underestimates renal function.
Adapted from NICEs guideline on chronic kidney disease in adults recommendations 161 and 162. The subdivision of stage 3 into 3a GFR 4559 mlmin173 m 2 and 3b 3044 mlmin173 m 2 and the addition of the suffix P to denote significant proteinuria at any stage. The UK eCKD Guide is derived from the NICE SIGN and Renal Association guidelines.
New 2014 114 In people with extremes of muscle mass for example in bodybuilders people who have had an amputation or people with muscle wasting disorders interpret eGFRcreatinine with caution. NICE concluded that general population screening is not cost-effective but targeted screening directed at high-risk groups is cost-effective as it helps to identify people with CKD at an earlier disease stage who may benefit most from ongoing monitoring and management to reduce the risk of complications and disease progression. To delineate an increased risk of adverse outcomes the 2008 NICE guideline on chronic kidney disease suggested 2 key changes to this classification.
GFR 60-89 mLmin173 m2 with other evidence of chronic kidney damage. NICE CG182 updated 2015. A more modern classification of chronic kidney disease CKD is based on estimated GFR and recognises five stages of kidney disease as follows 12.
How we develop NICE guidelines. Chronic kidney disease CKD is a reduction in kidney function or structural damage or both present for more than 3 months with associated health implications. 113 Apply a correction factor to GFR values estimated using the CKDEPI creatinine equation for people of African-Caribbean or African family origin multiply eGFR by 1159.
The definition of CKD includes all individuals with markers of kidney damage see below or those with an eGFR of less than 60 mlmin173m2 on at least 2 occasions 90 days apart with or without markers of kidney. Brief NICE guideline summary on the investigation classification monitoring and management of chronic kidney disease CKD in primary and secondary care. After discussing the risks and benefits of starting statin therapy with a healthcare professional adults with CKD may choose statin therapy as an appropriate treatment to reduce their risk of first CVD events or of future CVD events in adults who have already had an event such as a heart attack or stroke.
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. A UK retrospective longitudinal cohort study of data from more than 400 primary care practices in the General Practice Research Database in 2010 found the prevalence of CKD.
Pages of the eCKD Guide About eGFR CKD Stages Normal GFR CKD Stages G1 or G2 CKD Stage G3 CKD. Chronic kidney disease in adults. There is a higher risk of cardiovascular disease CVD in people with CKD.
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. 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. In people with CKD and diabetes and also in people with an ACR of 70 mgmmol or more aim to keep the systolic blood pressure below 130 mmHg target range 120129 mmHg and the diastolic blood pressure below 80 mmHg.
See the guideline in development page for progress on the update. CKD Definition A patient is said to have chronic kidney disease CKD if they have abnormalities of kidney function or structure present for more than 3 months. Markers of kidney damage such as proteinuria urinary albumincreatinine ratio ACR greater than 3 mgmmol urine sediment abnormalities electrolyte and other abnormalities due to.
GFR 90 mLmin173 m2 with other evidence of chronic kidney damage. General symptoms such as lethargy itch breathlessness cramps often worse at night sleep disturbance bone pain or loss of appetite vomiting weight loss and taste disturbance often present with end-stage disease. 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.