Excerpt

The Renal National Service Framework (NSF), and the subsequent NICE Clinical Practice Guideline for early identification and management of adults with chronic kidney disease (CKD) in primary and secondary care (CG73), served to emphasise the change in focus in renal medicine from treatment of established kidney disease to earlier identification and prevention of kidney disease.

CKD describes abnormal kidney function and/or structure. It is common, frequently unrecognised and often coexists with other conditions (for example, cardiovascular disease and diabetes). Moderate to severe CKD also carries an increased risk of other significant adverse outcomes such acute kidney injury, falls, frailty and mortality. The risk of developing CKD increases with increasing age, and some conditions that coexist with CKD become more severe and increasingly prevalent as kidney dysfunction advances. CKD can progress to end-stage kidney disease (ESKD)in a small but significant percentage of people.

CKD is usually asymptomatic but it is detectable, and tests for detecting CKD are both simple and freely available. There is evidence that treatment can prevent or delay the progression of CKD, reduce or prevent the development of complications and reduce the risk of cardiovascular disease. However, because of a lack of specific symptoms, CKD frequently remains undetected and unrecognised. As a consequence people with CKD are often not diagnosed, or diagnosed late when CKD is at an advanced stage. Late diagnosis is associated with increased morbidity, mortality and healthcare associated costs.

Contents

• Guideline update
• Guideline development group members
• Acknowledgments
• 1. Introduction
  • 1.1. Background
  • 1.2. Definition
  • 1.3. Burden of disease
• 2. Development of the guideline
  • 2.1. What is a NICE clinical guideline?
  • 2.2. Remit
  • 2.3. Who developed this guideline?
  • 2.4. What this guideline covers
  • 2.5. What this guideline does not cover
  • 2.6. Relationships between the guideline and other NICE guidance
• 3. Methods
  • 3.1. Methods (2014)
  • 3.2. Methods (2008)
• 4. Guideline summary
  • 4.1. Algorithms (2014)
  • 4.2. Key priorities for implementation 2014
  • 4.3. Full list of recommendations (2014)
  • 4.4. Key research recommendations (2014)
• 5. Investigating chronic kidney disease
  • 5.1. Measuring kidney function
  • 5.2. Factors affecting the biological and analytical variability of GFR estimated from measurement of serum creatinine
  • 5.3. Detection of blood and protein in the urine
  • 5.4. Urinary albumin: creatinine and protein: creatinine ratios, and their relationship to 24-hour urinary protein
  • 5.5. Managing isolated invisible haematuria
  • 5.6. Combining measures of kidney function and markers of kidney damage
  • 5.7. Recommendations and link to evidence
• 6. Classification of CKD
  • 6.1. The influence of GFR, age, gender, ethnicity and proteinuria on patient outcomes
  • 6.2. Who should be tested for CKD
  • 6.3. Acute kidney injury, diabetes, glomerular disease and hypertension as risk factors for CKD
  • 6.4. Indications for renal ultrasound in the evaluation of CKD
• 7. Progression of chronic kidney disease
  • 7.1. Frequency of monitoring
  • 7.2. Defining progression
  • 7.3. Risk factors associated with progression of CKD (2008)
  • 7.4. Risk factors associated with progression of CKD (2014) – Acute kidney injury
• 8. Information and education
  • 8.1. Information, education and support for people with CKD and their carers
  • 8.2. Available tools to aid identification and maximise effectiveness of treatment and management of CKD
  • 8.3. Lifestyle modification
  • 8.4. Dietary intervention and renal outcomes (2008)
  • 8.5. Low protein diets
  • 8.6. Self-management
• 9. Referral criteria
  • 9.1. Indications for referral to specialist care
  • Pharmacotherapy
  • Blood pressure control in people with CKD
• 10. Reducing cardiovascular disease
  • 10.1. Statin therapy and reduction in proteinuria
  • 10.2. Lipid lowering in people with CKD
  • 10.3. Oral antiplatelets and anticoagulants
• 11. Asymptomatic hyperuricaemia
  • 11.1. Asymptoamtic hyperuricaemia in CKD
• Other complications of chronic kidney disease
  • 12. Bone Metabolism and Osteoporosis
    • 12.1. Monitoring of calcium, phosphate, vitamin D and parathyroid hormone levels in people with CKD
    • 12.2. Risks and benefits of bisphosphonates for preventing osteoporosis in adults with CKD
    • 12.3. Vitamin D supplements in the management of CKD-mineral and bone disorders
  • 13. Anaemia
    • 13.1. Anaemia identification in people with CKD
  • 14. Oral bicarbonate supplements
    • 14.1. Oral bicarbonate supplements in the management of metabolic acidosis in people with CKD
• 15. Reference list
• 16. Acronyms and abbreviations
• 17. Glossary
• Appendices
  • Appendix A. Scope
  • Appendix B. Declarations of interest
  • Appendix C. Review protocols
  • Appendix D. Clinical article selection (2014)
  • Appendix E. Economic article selection
  • Appendix F. Literature search strategies
  • Appendix G. Clinical evidence tables
  • Appendix H. Economic evidence tables
  • Appendix I. Forest plots
  • Appendix J. Excluded clinical studies
  • Appendix K. Excluded economic studies
  • Appendix L. Cost-effectiveness analysis: cystatin C testing in the diagnosis of CKD
  • Appendix M. Cost-effectiveness analysis: Novel oral anticoagulants for people with CKD and non-valvular atrial fibrillation
  • Appendix N. Changes to recommendations from 2008 guideline
  • Appendix O. Deleted content from 2008 guideline
  • Appendix P. Deleted appendices from 2008 guideline
  • Appendix Q. References

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.