Early identification and management of chronic kidney disease in adults in primary and secondary care: a commentary on NICE Guideline No 73,Sept 2008

Abstract

Chronic kidney disease (CKD) is common, but more than 30% of people with CKD are referred late, leading to increased morbidity and mortality. An updated classification of CKD, using estimated glomerular filtration rate (eGFR) allows the severity of CKD to be determined and when it is appropriate to refer to a consultant nephrologist. New approaches to the measurement of protein excretion are stressed with particular reference to using urine albumin:creatinine ratio or urine protein:creatinine ratio. Annual measurement of serum creatinine in at-risk patients is clearly outlined as are the indications for renal ultrasound examination. Two algorithms for the management of newly detected abnormal eGFR and for the management of CKD, Stages 3—5, are not in the NICE Guideline No 73 document but reflect the author's clinical experience of working in this area, with the aim of simplifying these two important topics. The safe use of angiotensin-converting-enzyme (ACE) inhibitors and angiotensin blocking agents in the everyday clinical work place is outlined.

The management of CKD due to diabetic nephropathy and hypertension is an important part of diabetes management and this review of NICE Guideline No 73 on the early identification and management of CKD in adults in both primary and secondary care settings will further enable the better care of type 1 and type 2 diabetic subjects with renal impairment. Br J Diabetes Vasc Dis 2008; 8: 257—262