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Chronic kidney disease (partial update) National clinical guideline for early identification and management in adults in primary and secondary care

By: Series: NICE clinical guidelinePublication details: London National Institute for Health and Care Excellence 2014Online resources: Summary: <p style="margin: 0.6923em 0px; font-family: &quot;Times New Roman&quot;, serif; font-size: 15.9991px; line-height: 21.9988px;"><span style="font-size: 10pt;">The&nbsp;<span class="term-highlight">Renal</span>&nbsp;National Service Framework (NSF), and the subsequent NICE Clinical Practice Guideline for early identification and management of adults with&nbsp;<span class="term-highlight">chronic</span>&nbsp;<span class="term-highlight">kidney</span>&nbsp;<span class="term-highlight">disease</span>&nbsp;(CKD) in primary and secondary care (CG73), served to emphasise the change in focus in&nbsp;<span class="term-highlight">renal</span>&nbsp;medicine from treatment of established&nbsp;<span class="term-highlight">kidney</span>&nbsp;<span class="term-highlight">disease</span>&nbsp;to earlier identification and prevention of&nbsp;<span class="term-highlight">kidney</span>&nbsp;<span class="term-highlight">disease</span>.</span></p><p style="margin: 0.6923em 0px; font-family: &quot;Times New Roman&quot;, serif; font-size: 15.9991px; line-height: 21.9988px;"><span style="font-size: 10pt;">CKD describes abnormal&nbsp;<span class="term-highlight">kidney</span>&nbsp;function and/or structure. It is common, frequently unrecognised and often coexists with other conditions (for example, cardiovascular&nbsp;<span class="term-highlight">disease</span>&nbsp;and diabetes). Moderate to severe CKD also carries an increased risk of other significant adverse outcomes such acute&nbsp;<span class="term-highlight">kidney</span>&nbsp;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&nbsp;<span class="term-highlight">kidney</span>&nbsp;dysfunction advances. CKD can progress to end-stage&nbsp;<span class="term-highlight">kidney</span>&nbsp;<span class="term-highlight">disease</span>&nbsp;(ESKD)in a small but significant percentage of people.</span></p><p style="margin: 0.6923em 0px; font-family: &quot;Times New Roman&quot;, serif; font-size: 15.9991px; line-height: 21.9988px;"><span style="font-size: 10pt;">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&nbsp;<span class="term-highlight">disease</span>. 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.</span></p><p style="margin: 0.6923em 0px; font-family: &quot;Times New Roman&quot;, serif; font-size: 15.9991px; line-height: 21.9988px;"><span style="font-size: 10pt;"><span style="line-height: 21.9988px;">The original NICE guidance and supporting documents are available from&nbsp;</span></span><a href="http://publications.nice.org.uk/chronic-kidney-disease-cg73/" style="color: #642a8f; font-size: 15.9991px; line-height: 21.9988px;"><span style="font-size: 10pt;">http://publications.nice.org.uk/<span class="term-highlight" style="font-weight: bold;">chronic</span>-<span class="term-highlight" style="font-weight: bold;">kidney</span>-<span class="term-highlight" style="font-weight: bold;">disease</span>-cg73/</span></a></p>
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&lt;p style="margin: 0.6923em 0px; font-family: &amp;quot;Times New Roman&amp;quot;, serif; font-size: 15.9991px; line-height: 21.9988px;"&gt;&lt;span style="font-size: 10pt;"&gt;The&amp;nbsp;&lt;span class="term-highlight"&gt;Renal&lt;/span&gt;&amp;nbsp;National Service Framework (NSF), and the subsequent NICE Clinical Practice Guideline for early identification and management of adults with&amp;nbsp;&lt;span class="term-highlight"&gt;chronic&lt;/span&gt;&amp;nbsp;&lt;span class="term-highlight"&gt;kidney&lt;/span&gt;&amp;nbsp;&lt;span class="term-highlight"&gt;disease&lt;/span&gt;&amp;nbsp;(CKD) in primary and secondary care (CG73), served to emphasise the change in focus in&amp;nbsp;&lt;span class="term-highlight"&gt;renal&lt;/span&gt;&amp;nbsp;medicine from treatment of established&amp;nbsp;&lt;span class="term-highlight"&gt;kidney&lt;/span&gt;&amp;nbsp;&lt;span class="term-highlight"&gt;disease&lt;/span&gt;&amp;nbsp;to earlier identification and prevention of&amp;nbsp;&lt;span class="term-highlight"&gt;kidney&lt;/span&gt;&amp;nbsp;&lt;span class="term-highlight"&gt;disease&lt;/span&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p style="margin: 0.6923em 0px; font-family: &amp;quot;Times New Roman&amp;quot;, serif; font-size: 15.9991px; line-height: 21.9988px;"&gt;&lt;span style="font-size: 10pt;"&gt;CKD describes abnormal&amp;nbsp;&lt;span class="term-highlight"&gt;kidney&lt;/span&gt;&amp;nbsp;function and/or structure. It is common, frequently unrecognised and often coexists with other conditions (for example, cardiovascular&amp;nbsp;&lt;span class="term-highlight"&gt;disease&lt;/span&gt;&amp;nbsp;and diabetes). Moderate to severe CKD also carries an increased risk of other significant adverse outcomes such acute&amp;nbsp;&lt;span class="term-highlight"&gt;kidney&lt;/span&gt;&amp;nbsp;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&amp;nbsp;&lt;span class="term-highlight"&gt;kidney&lt;/span&gt;&amp;nbsp;dysfunction advances. CKD can progress to end-stage&amp;nbsp;&lt;span class="term-highlight"&gt;kidney&lt;/span&gt;&amp;nbsp;&lt;span class="term-highlight"&gt;disease&lt;/span&gt;&amp;nbsp;(ESKD)in a small but significant percentage of people.&lt;/span&gt;&lt;/p&gt;&lt;p style="margin: 0.6923em 0px; font-family: &amp;quot;Times New Roman&amp;quot;, serif; font-size: 15.9991px; line-height: 21.9988px;"&gt;&lt;span style="font-size: 10pt;"&gt;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&amp;nbsp;&lt;span class="term-highlight"&gt;disease&lt;/span&gt;. 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.&lt;/span&gt;&lt;/p&gt;&lt;p style="margin: 0.6923em 0px; font-family: &amp;quot;Times New Roman&amp;quot;, serif; font-size: 15.9991px; line-height: 21.9988px;"&gt;&lt;span style="font-size: 10pt;"&gt;&lt;span style="line-height: 21.9988px;"&gt;The original NICE guidance and supporting documents are available from&amp;nbsp;&lt;/span&gt;&lt;/span&gt;&lt;a href="http://publications.nice.org.uk/chronic-kidney-disease-cg73/" style="color: #642a8f; font-size: 15.9991px; line-height: 21.9988px;"&gt;&lt;span style="font-size: 10pt;"&gt;http://publications.nice.org.uk/&lt;span class="term-highlight" style="font-weight: bold;"&gt;chronic&lt;/span&gt;-&lt;span class="term-highlight" style="font-weight: bold;"&gt;kidney&lt;/span&gt;-&lt;span class="term-highlight" style="font-weight: bold;"&gt;disease&lt;/span&gt;-cg73/&lt;/span&gt;&lt;/a&gt;&lt;/p&gt;

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