Local Guidance on review of CKD patients (summarised from NICE guidance CG182)
A number of our GP colleagues have suggested we should give some guidance regarding testing for CKD for patients with and without diabetes mellitus.
Frequency of testing
- Monitor GFR at least annually in people prescribed drugs known to be nephrotoxic e.g NSAIDs, lithium
- Annually in all at-risk groups* using eGFR and urinalysis.
- Confirm a eGFR <60 ml/min/1.73 m2sup in a patient not previously tested within 2 weeks (account for biological/analytical variation of creatinine (± 5%)). The ACR should be quantified in these patients with an EMU.
- - If eGFR is stable, test for eGFR should be repeated after 90 days
- - If eGFR is decreasing, two further repeat tests for eGFR should be requested within 90 days
- During intercurrent illness/peri-operatively in CKD patients.
- For patients with CKD refer to
local CKD GP Management Pathway available via the
GP Gateway
Interpretation of ACR result
NB. Urine ACR is the preferred method of measurement due to its greater sensitivity for detection of low levels of proteinuria; it is the recommended method for diabetic patients.
- Non-diabetic patients - For initial detection, if ACR >3 mg/mmol and <70 mg/mmol, confirm with subsequent EMU. An ACR of >3 mg/mmol is clinically significant. If initial ACR >70 mg/mmol a repeat sample is not required.
- Diabetic patients - ACR >3 mg/mmol is clinically significant.
* Risk factors include DM, hypertension, CVD, FHx of renal disease, structural renal tract disease, multisystem disease with potential kidney involvement and opportunistic detection of haematuria
NICE Guidelines http://publications.nice.org.uk/chronic-kidney-disease-cg73/guidance