Greater Manchester Adult CKD Management Overview: A Comprehensive Approach

🌟 Welcome to our deep dive into CKD management, guided by the Greater Manchester Adult CKD Management Overview. This approach emphasizes proactive screening, accurate diagnosis, and effective management strategies.

📊 Screening for CKD:

Regular eGFR checks are recommended for those with diabetes (annually), hypertension (1-5 years), heart failure/cardiovascular disease, and other risk factors like chronic NSAID/Lithium use or previous AKI.

🔍 Diagnosing CKD:

CKD is diagnosed with eGFR < 60mL/min for more than 3 months, or structural abnormalities, or proteinuria (ACR >30mg/mmol), or haematuria.

🔬 Measuring ACR:

ACR should be measured in all adults with eGFR < 60 mmol/L, and in all diabetics & hypertensives.

uACR between 3mg/mmol to 70mg/mmol requires confirmation with an early morning sample. If > 70mg/mmol, no confirmation is needed.

📌 Renal Ultrasound Indications:

Consider if there’s rapid eGFR decline, suspected obstruction or cystic kidney disease, eGFR < 30 mL/min, or visible/persistent haematuria.

💻 Inform and Code:

Ensure CKD is coded correctly on GP records. Suggested patient resources include Kidney Care UK and NHS websites.

📈 Establishing Risk:

Use the 4 variable five-year Kidney Failure Risk Equation (KFRE), which requires age, sex, uACR, and eGFR.

🩺 Management Steps:

STEP ONE – ACE/ARB: Prescribe to the maximum tolerated dose if diabetic or if uACR is >30mg/mmol in non-diabetics.

STEP TWO – SGLTi: Add to max tolerated ACE/ARB in patients with CKD, eGFR >20mL/min & uACR > 25mg/mmol (irrespective of diabetes status). Also beneficial for T2DM with eGFR 20-45 and no proteinuria.

STEP THREE – Address Cardiovascular Risk: Aim for BP targets (<140/90mmHg if uACR <70mg/mmol, <130/80mmHg if >70mg/mmol), prescribe statins, provide lifestyle advice, and consider Finerenone for T2DM patients (under specialist advice).

🚩 Consider Referral:

If 5-year KFRE is > 5%, uACR >70 mg/mmol (unless optimally treated DM), or uACR >30 mg/mmol with haematuria.

👨‍⚕️👩‍⚕️ As healthcare professionals, this comprehensive approach enables us to screen, diagnose, and manage CKD more effectively. By following these guidelines, we can significantly improve outcomes for our patients with CKD.

#CKDManagement #KidneyHealth #PrimaryCare #HealthcareGuidelines #ManchesterCKDOverview

https://healthinnovationmanchester.com/wp-content/uploads/2023/10/5_CKD-Management-Toolkit-vF1.1-1.pdf

Author

Mohammed Rashad
Director, The Medicines Management Team

Mohammed Rashad is a pharmacist and Director at The Medicines Management Team (TMMT), an award-winning provider of pharmacy services supporting over 85 Primary Care Networks (PCNs) and 250 GP practices across the UK. He works at scale with practices and PCNs to reduce workload, improve access, and deliver key targets such as QOF. Mohammed combines clinical expertise with strategic leadership to redesign how primary care operates. He leads on digital innovation, implementing performance dashboards, optimising workflows, and using data to drive smarter decisions. His work focuses on building scalable, high-performing models that deliver measurable impact. He regularly shares practical insights on improving efficiency, workforce productivity, and patient outcomes across primary care.