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