CKD Advisor

The aim is to identify patients at risk of progressive renal disease an reduce associated risks.
  • NICE CKD Guidelines UK eCKD Guidelines
  • KDOQI CKD Guidelines KDOQI CKD Highlight summary
  • BC CKD Guidelines
  • What is CKD? Treatment and care options: Who should be offered screening for CKD? Color code
    Patient name Date:
    Patients age: Sex:
    Ethnic origin

    Aboriginal

    African

    Asian

    European

    South Asian

    Other


    Existing medical conditions:

    Diabetes

    HBP

    IHD

    CVD

    Structural Renal Disease

    Persistent hematuria

    FH polycystic kidney disease

    Laboratory data:

    BMI

    BP

    Albumin

    Ca

    PO4

    iPTH

    eGFR

    ACR

    Hb

    TSAT

    LDL

    A1C

    BaseGFR

    CKD Stage: Presentation Suggested ongoing monitoring

    At Risk

    At higher risk include those with Diabetes,Hypertension,FH of CKD,Ethnic eGFR/ACR Q12-24M

    Stage 1

    Normal renal function with evidence of kidney disease eGFR/ACR Q12M

    Stage 2

    Mildly reduced renal function (eGFR 60-89) with evidence of kidney disease eGFR/ACR Q12M

    Stage 3

    Moderately reduced renal function:(eGFR 30-59) (eGFR 45-59(3A) or 30-44(3B)) eGFR/ACR Q6M: Consider Hb/Ca/Alb/PO4/iPTH/Transferrin Sat Q12M

    Stage 4

    Severely reduced renal function (eGFR 15-29) As per nephrologist

    Stage 5

    Very severely reduced renal function (Endstage) (eGFR < 15) As per nephrologist
    Management options:

    Lifestyle changes and risk factor modification

    Diabetes

    Hypertension

    BMI > 25

    LDL > 2.4

    Consider iron supplementation

    Hb < 110

    TSAT < 0.2

    Consider reducing phosphate in diet

    PO4 > 1.5

    Consider adding calcium supplementation

    Serum Ca < 2.1

    Serum PO4 > 1.5

    Consider adding Vit D to reach a target iPTH based on the kidney stage

    Stage 3 iPTH 3.8-7.7

    Stage 4 iPTH 7.7-12

    Stage 5 iPTH 16.5-33

    Consider improving blood pressure control: Target

    <140/90

    < 130/80 if proteinuria (ACR>30)

    Consider ACEi or ARB

    DM + ACR >1.9/2.7

    HBP + ACR >29

    ACR > 69

    Other strategies:

    Encourage annual influenza vaccination and check pneumococcal vaccination status

    Consider renal US

    eGFR<30

    FH Polycystic KD

    Persistent hematuria

    Declining eGFR

    Consider referring for nephrology consultation

    eGFR<30

    ACR>69

    ACR>29+hematuria

    Declining eGFR

    Statin and antiplatelet use

    Consider investigating for iron overload:

    TSAT > 0.45

    Iron Overload Guidelines


    Subject: