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

SW Thames Renal & Transplantation Unit, St Helier Hospital, Carshalton, Surrey, SM5 1AA, peter.andrews{at}epsom-sthelier.nhs.uk

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

Key Words: chronic kidney disease • NICE • nephropathy

References

• National Institute for Health and Clinical Excellence. Chronic kidney disease. Early identification and management of chronic kidney disease in adults in primary and secondary care. NICE clinical guideline 73. NICE, London, 2008. http://www.nice.org.uk/guidance/index.jsp?action=download&o=42116 (Accessed October 2008)
• National Institute for Health and Clinical Excellence. Hypertension: management of hypertension in adults in primary care. NICE clinical guideline 34. NICE, London, 2006. http://www.nice.org.uk/Guidance/CG34 (Accessed October 2008)
• National Institute for Health and Clinical Excellence. Anaemia management in people with chronic kidney disease. NICE clinical guideline 39. NICE, London, 2006. http://www.nice.org.uk/Guidance/CG39 (Accessed October 2008)
• National Institute for Health and Clinical Excellence. Type 2 diabetes. The management of type 2 diabetes. NICE clinical guideline 66. NICE, London, 2008. http://www.nice.org.uk/Guidance/CG66 (Accessed October 2008)
• National Institute for Health and Clinical Excellence. Lipid modification. Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. NICE clinical guidance 67. NICE, London, 2008. http://www.nice.org.uk/Guidance/CG67 (Accessed October 2008)

The British Journal of Diabetes & Vascular Disease, Vol. 8, No. 6, 257-262 (2008)
DOI: 10.1177/1474651408100414


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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Andrews, P. A Search for Related Content Social Bookmarking                         What's this?