Antihyperglycemic therapies (Type 2 Diabetes): New drugs are now recommended, including sodium–glucose cotransporter-2 inhibitors (SGLT2i), in combination with lifestyle therapy and other drugs for glycemic control. Consider referral at earlier stageto assist with diagnosis of underlying cause and/or treatment of common complications of CKD. h�bbd```b``�"ׂH� ��̞&�@$�X�t��L����j���=`5 ��Drz��]`�&�d���$��� r��H[5��}�6�sDz������b@�/�#w�4F������0 `)� This COVID-19 rapid guideline aims to maximise the safety of adults with chronic kidney disease during the COVID-19 pandemic. Available from: www.nice.org.uk/guidance/CG182. Includes updated recommendations on management and investigations on the causes of heavy menstrual bleeding. The following topics are suggested. In the absence of metabolic syndrome, diabetes or hypertension, do not use obesity alone as a risk marker to test people for CKD. In February 2014, the Canadian Society of Nephrology released new guidelines that recommend delaying dialysis in CKD patients without symptoms until their estimated glomerular filtration rate (eGFR) drops to 6 mL/min/1.73 m2 or until the first onset of a clinical indication (which includes symptoms of uremia, fluid overload, and refractory hyperkalemia or acidemia). Increase physical exercise to at least 150 minutes a week. when appropriate, offer information about renal replacement therapy (such as the frequency and length of time of dialysis treatment sessions or exchanges and pre-emptive transplantation) and the preparation required (such as having a fistula or peritoneal catheter), conservative management and when it may be considered, Offer people with CKD high-quality information or education programmes as appropriate to the severity of their condition to allow time for them to fully understand and make informed choices about their treatment, Healthcare professionals providing information and education programmes should ensure they have specialist knowledge about CKD and the necessary skills to facilitate learning, Healthcare professionals working with people with CKD should take account of the psychological aspects of coping with the condition and offer access to appropriate support – for example, support groups, counselling or a specialist nurse, Encourage people with CKD to take exercise, achieve a healthy weight and stop smoking, Offer dietary advice about potassium, phosphate, calorie and salt intake appropriate to the severity of CKD, Where dietary intervention is agreed this should occur within the context of education, detailed dietary assessment and supervision to ensure malnutrition is prevented, Do not offer low-protein diets (dietary protein intake less than 0.6–0.8g/kg/day) to people with CKD, inform people with CKD of their diagnosis, enable people with CKD to share in decision-making about their care, support self-management (this includes providing information about blood pressure, smoking cessation, exercise, diet and medicines) and enable people to make informed choices, Give people access to their medical data (including diagnosis, comorbidities, test results, treatments and correspondence) through information systems, such as, Take into account the individual's wishes and comorbidities when considering referral. Progression of chronic kidney disease CKD can be slowed with early detection and management of patients; many patients with risk factors for CKD are treated in primary care. T`�#d���\)�� 2!�B����P��@�Nw�P��-.�̄�q@qO� gO����[u&�) �b�����'�N����f!�V���Nq�ǃ|]9,\. The guideline comes at a pivotal time, with substantial growth in the public health burden of diabetes and chronic kidney disease (CKD), and with recent development of new therapies applicable to this population. Work with people who have any of the following risk factors for CKD progression to optimise their health: African, African-Caribbean or Asian family origin, untreated urinary outflow tract obstruction, In people with CKD the chronic use of NSAIDs may be associated with progression and acute use is associated with a reversible decrease in GFR. Blood pressure level above 130/80 mmHg in CKD patients requires lifestyle modifications and multiple antihypertensive medications. in chronic kidney disease 2015(3) and adopts in this guideline update the nomenclature for classifying CKD from the NICE Guideline for chronic kidney disease in adults 2014 (4) . The new 4th edition of our popular handbook 'Chronic Kidney Disease (CKD) Management in Primary Care' is now available. If the eGFR change is 25% or more, or the change in serum creatinine is 30% or more: investigate other causes of a deterioration in renal function, such as volume depletion or concurrent medication (for example, NSAIDs), if no other cause for the deterioration in renal function is found, stop the renin–angiotensin system antagonist or reduce the dose to a previously tolerated lower dose, and add an alternative antihypertensive medication if required, Offer antiplatelet drugs to people with CKD for the secondary prevention of cardiovascular disease, but be aware of the increased risk of bleeding, Consider apixaban in preference to warfarin in people with a confirmed eGFR of 30–50 ml/min/1.73m, prior stroke or transient ischaemic attack. With the recent publication of multiple randomized controlled trials of statin therapy in CKD patients, the Kidney Disease: Improving Global Outcomes (KDIGO) organization updated their clinical practice guidelines in 2013 to summarize evidence and recommend lipid management for all forms of CKD. This handbook is a highly regarded, evidence-based source of information, providing guidance and clinical tips to help you detect, manage and refer patients in your practice with CKD. Kidney Disease: Improving Global Outcomes has published a practice guideline for diabetes management in patients with chronic kidney disease. The Kidney Disease: Improving Global Outcomes (KDIGO) 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (CKD) represents the first KDIGO guideline on this subject. • Medication advice and treatment targets. A. Included on this page is a collection of key guidance and advice from PHE and the NHS, as well as a list of information for specific groups from a range of professional bodies. 3033 0 obj <> endobj CKD is a worldwide public health problem. These recommendations and treatment targets may not be appropriate in all cases because many patients with CKD are complex due to older age and comorbidities. NICE accepts no responsibility for the use of its content in this product/publication. The Guidelines team has produced the following directory of COVID-19 information and guidance for primary care. What led to a new diabetes in CKD guideline? The scope includes topics such as comprehensive care, glycemic monitoring and targets, lifestyle and antihyperglycemic interventions, and approaches to self-management and optimal models of care. See table below to guide the frequency of GFR monitoring for people with, or at risk of, CKD, but tailor it to the person according to: past patterns of eGFR and ACR (but be aware that CKD progression is often non-linear), changes to their treatment (such as renin–angiotensin–aldosterone system [RAAS] antagonists, NSAIDs and diuretics), whether they have chosen conservative management of CKD. Read about our cookies here.. © NICE 2015. NICE guidance is prepared for the National Health Service in England. This COVID-19 rapid guideline aims to maximise the safety of adults with chronic kidney disease during the COVID-19 pandemic. These guidelines describe key aspects of the management of chronic kidney disease to facilitate shared care for these patients by general … • Management framework for common CKD complications. h�b```����\B cc`a�� "��ӟ#MA�4�]Y�U�g�80�ARB�:ǍC_(zrT6)=h������d�P�#���������Bb^R��k�x��tR1dm}�i.���3#�Qdr�@����A �'�r��d2��%?�FC��+�C�x&��p��S In 2002, the National Kidney Foundation (NKF) published treatment guidelines that delineated five stages of CKD based on Define accelerated progression of CKD as: a sustained decrease in GFR of 25% or more and a change in GFR category within 12months, a sustained decrease in GFR of 15ml/min/1.73m. Persistent gaps exist in care for patients with chronic kidney disease (CKD), such as inadequate blood pressure (BP) control and low use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and statins.1 There are multiple barriers to optimal CKD care, including: (1) low general public awareness about CKD, its risk factors, and its consequences; (2) lack … • Refer CKD stage G4 or G5 (see Table 2) to nephrology for co- management and preparation for renal replacement therapy. If you continue to use the site, we will assume you are happy to accept the cookies anyway. Because this disease can silently progress to advanced stages, early detection is critical for initiating timely interventions. This Guidelines summary covers the provision of care for patients requiring dialysis in the context of the COVID-19 outbreak. Repeat these measurements between 1 and 2weeks after starting renin–angiotensin system antagonists and after each dose increase, Do not routinely offer a renin–angiotensin system antagonist to people with CKD if their pretreatment serum potassium concentration is greater than 5.0mmol/litre, When hyperkalaemia precludes use of renin–angiotensin system antagonists, assessment, investigation and treatment of other factors known to promote hyperkalaemia should be undertaken and the serum potassium concentration rechecked, Concurrent prescription of drugs known to promote hyperkalaemia is not a contraindication to the use of renin–angiotensin system antagonists, but be aware that more frequent monitoring of serum potassium concentration may be required, Stop renin–angiotensin system antagonists if the serum potassium concentration increases to 6.0mmol/litre or more and other drugs known to promote hyperkalaemia have been discontinued, Following the introduction or dose increase of renin–angiotensin system antagonists, do not modify the dose if either the GFR decrease from pretreatment baseline is less than 25% or the serum creatinine increase from baseline is less than 30%, If there is a decrease in eGFR or increase in serum creatinine after starting or increasing the dose of renin–angiotensin system antagonists, but it is less than 25% (eGFR) or 30% (serum creatinine) of baseline, repeat the test in 1–2 weeks. This site uses cookies, some may have been set already. A guide to identify, manage and refer patients with CKD. Chronic kidney disease affects 47 million people in the United States and is associated with significant health care costs, morbidity, and mortality. The National Kidney Foundation defines chronic kidney disease (CKD) as a glomerular filtration rate (GFR) of less than 60 mL per minute per 1.73 … For patients with established CKD and/or diabetes with albuminuria, the updated hypertension guidelines have recommended a blood pressure (BP) goal < 130/80 mmHg. Be aware that: increased ACR is associated with increased risk of adverse outcomes, decreased GFR is associated with increased risk of adverse outcomes, increased ACR and decreased GFR in combination multiply the risk of adverse outcomes, Do not determine management of CKD solely by age, Agree a plan to establish the cause of CKD during an informed discussion with the person with CKD, particularly if the cause may be treatable (for example, urinary tract obstruction, nephrotoxic drugs or glomerular disease), Use the person's GFR and ACR categories to indicate their risk of adverse outcomes (for example, CKD progression, acute kidney injury, all-cause mortality and cardiovascular events) and discuss this with them. Sankar D. Navaneethan, M.D., from the Baylor College of Medicine in Houston, and colleagues provide a summary of the KDIGO guidelines for diabetes management in CKD. CKD WEBSITES OF INTEREST 69 C AUTHORS 69 WEBSITE MANAGEMENT 70 P INFORMATION 70 CHRONIC KIDNEY DISEASE CHECKLIST 71 LAN OF CARE &ACTION PLAN 36 DIAGRAMS 14 Approach to Hypertension Treatment in CKD 23 CKD Proteinuria Evaluation 27 Management of Mineral-Bone Disease in CKD 39 CKD Dyslipidemia Treatment 42 how can people cope with and adjust to CKD and what sources of psychological support are available? Management of Chronic Kidney Disease (CKD) (2019) Newly Updated! Welcome to Guidelines. This is the first Kidney Disease: Improving Global Outcomes (KDIGO) Guideline for Diabetes Management in Chronic Kidney Disease. ISFM Consensus Guidelines on the Diagnosis and Management of Feline Chronic Kidney Disease Practical relevance: Chronic kidney disease (CKD) is one of the most commonly diagnosed diseases in older cats. All NICE guidance is subject to regular review and may be updated or withdrawn. All rights reserved. This guideline update covers the management of anaemia in adults, children and young people with anaemia Be aware that people with CKD are at increased risk of progression to end-stage kidney disease if they have either of the following: a sustained decrease in GFR of 25% or more over 12 months, When assessing CKD progression, extrapolate the current rate of decline of GFR and take this into account when planning intervention strategies, particularly if it suggests that the person might need renal replacement therapy in their lifetime. In most cats, CKD is also a progressive disease and can be accompanied by a wide range of clinical and clinicopathological changes. The guidelines … To improve concordance, inform people who are prescribed renin–angiotensin system antagonists about the importance of: achieving the optimal tolerated dose of renin–angiotensin system antagonists, monitoring eGFR and serum potassium in achieving this safely, In people with CKD, measure serum potassium concentrations and estimate the GFR before starting renin–angiotensin system antagonists. what questions should people ask about their kidneys? • For CKD stages G3b-G5, monitor labs more frequently due to increased risk for hyperkalemia. Chronic kidney disease in adults: assessment and management. Classify CKD using a combination of GFR and ACR categories. Therefore, antihyperglycemic management in patients with type 1 diabetes should follow the recommendations of general diabetes guidelines. Additional factors that may affect dialysis initiation include patient e… what is CKD and how does it affect people? Nutrition Guidelines. It also aims to protect staff from infection and enable services to make the best use of NHS resources. %PDF-1.6 %���� [51, 52] Close monitoring should begin when eGFR reaches 15 mL/min/1.73 m2. Chronic kidney disease (CKD) Defined as abnormalities of kidney function or structure present for more than 3 months, with implications for health. It aims to improve assessment and detection by non-specialists, and specifies when people should be referred to specialist services. Introduction. It also aims to protect staff from infection and enable services to make the best use of NHS resources. Communication between primary care providers and specialists is strongly encouraged. Subject to Notice of rights. Multiple guidelines recommend at least annual screening with serum creatinine, urine albumin/creatinine ratio, and urinalysis for patients with risk factors, par… 3063 0 obj <>/Filter/FlateDecode/ID[<6CA9C4FAC1DFFC499E6D6A377FC14582><13027BDDA1CEB243880CB102817B9CA7>]/Index[3033 52]/Info 3032 0 R/Length 139/Prev 621946/Root 3034 0 R/Size 3085/Type/XRef/W[1 3 1]>>stream Exercise caution when treating people with CKD with NSAIDs over prolonged periods of time. In 2020, the Chronic Kidney Disease (CKD) Management in Primary Care (4th Edition) handbook was released by Kidney Health Australia, replacing the 2015 3rd Edition.The handbook provides guidance and clinical tips to help detect, manage and refer patients in your practice with CKD. It aims to prevent or delay the progression of chronic kidney disease, reduce or prevent the development of complications, and reduce the risk of cardiovascular disease. 0 NICE has produced a COVID-19 rapid guideline on chronic kidney disease. 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