Chronic kidney disease quality standard

People with risk factors for CKD are offered testing, and people with CKD are correctly identified. People with CKD who may benefit from specialist care are referred for specialist assessment in accordance with NICE guidance. People with CKD have a current agreed care plan appropriate to the stage and rate of progression of CKD. People with CKD are assessed for cardiovascular risk. People with higher levels of proteinuria, and people with diabetes and microalbuminuria, are enabled to safely maintain their systolic blood pressure within a target range 120-129 mmHg and their diastolic blood pressure below 80 mmHg. People with CKD are assessed for disease progression. People with CKD who become acutely unwell have their medication reviewed, and receive an assessment of volume status and renal function. People with anaemia of CKD have access to and receive anaemia treatment in accordance with NICE guidance. People with progressive CKD whose eGFR is less than 20 ml/min/1.73m2, and/or who are likely to progress to established kidney failure within 12 months, receive unbiased personalised information on established kidney failure and renal replacement therapy options. People with established renal failure have access to psychosocial support (which may include support with personal, family, financial, employment and/or social needs) appropriate to their circumstances. People with CKD are supported to receive a pre-emptive kidney transplant before they need dialysis, if they are medically suitable. People with CKD on dialysis are supported to receive a kidney transplant, if they are medically suitable. People with established kidney failure start dialysis with a functioning arteriovenous fistula or peritoneal dialysis catheter in situ. People on long-term dialysis receive the best possible therapy, incorporating regular and frequent application of dialysis and ideally home-based or self-care dialysis. People with CKD receiving haemodialysis or training for home therapies who are eligible for transport, have access to an effective and efficient transport service.

Chronic kidney disease Identification Specialist referral Planning care Cardiovascular risk Blood pressure control Progression Acute illness Anaemia treatment Preparing for renal replacement therapy Psychosocial support Transplantation - pre-emptive Transplantation - on dialysis Dialysis access Best possible dialysis Patient transport

• Full chronic kidney disease quality standard (PDF format)

This NICE quality standard defines clinical best practice within this topic area. It provides specific, concise quality statements, measures and audience descriptors to provide patients and the public, health and social care professionals, commissioners and service providers with definitions of high-quality care.

Rationale for developing this quality standard

Chronic kidney disease (CKD) describes abnormal kidney function and/or structure. It is common, frequently unrecognised and often exists together with other conditions (for example, cardiovascular disease and diabetes). The Health Survey for England 2009 estimates that the prevalence of adult CKD in England is around 13%. The risk of developing CKD increases with increasing age, and some conditions that coexist with CKD become more severe as kidney dysfunction advances. CKD is usually characterised by an asymptomatic period, which is potentially detectable. Tests for detecting CKD are both simple and widely available and there is evidence that treatment can prevent or delay progression of CKD, reduce or prevent the development of complications, and reduce the risk of cardiovascular disease (CVD). In cases where progression cannot be prevented, CKD may progress to established renal failure, requiring life-saving dialysis or kidney transplant. This quality standard describes markers of high-quality, cost-effective care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for adults with chronic kidney disease.

Scope of the quality standard

Identification, assessment and clinical management of chronic kidney disease (CKD) in adults including the management of established renal failure.

Chronic kidney disease quality statements

The quality standard for chronic kidney disease (CKD) in adults requires that services should be commissioned from and coordinated across all relevant agencies encompassing the whole CKD care pathway. An integrated approach to provision of services is fundamental to the delivery of high quality care to people with CKD.

Unless otherwise stated, the term CKD in this quality standard describes collectively stages 1 to 5 of CKD. See appendix 1 for details.

Chronic kidney disease areas of care map: view the quality statements mapped against the areas of chronic kidney disease.

Key development sources

Primary evidence source

Anaemia management in people with chronic kidney disease. NICE clinical guideline 114 (2011; NHS Evidence accredited). Available from www.nice.org.uk/CG114

Chronic kidney disease: early identification and management of chronic kidney disease in adults in primary and secondary care. NICE clinical guideline 73 (2008; NHS Evidence accredited). Available from www.nice.org.uk/CG73

Anaemia management in people with chronic kidney disease. NICE clinical guideline 39 (2006; NHS Evidence accredited) (now replaced by NICE clinical guideline 114). Available from www.nice.org.uk/CG39

Guidance on home compared with hospital haemodialysis for patients with end-stage renal failure. NICE technology appraisal 48 (2002; NHS Evidence accredited). Available from www.nice.org.uk/TA48

The Renal Association (2011) Clinical practice guideline: acute kidney injury. Available from www.renal.org

The Renal Association (2011) Clinical practice guideline: vascular access for haemodialysis. Available from www.renal.org

The Renal Association (2010) Clinical practice guideline: assessment of the potential kidney transplant recipient. Available from www.renal.org

The Renal Association (2010) Clinical practice guideline: cardiovascular disease in CKD. Available from www.renal.org

The Renal Association (2010) Clinical practice guideline: peritoneal dialysis. Available from www.renal.org

The Renal Association (2009) Clinical practice guideline: haemodialysis. Available from www.renal.org

The Renal Association (2009) Clinical practice guideline: peritoneal access. Available from www.renal.org

The Renal Association (2009) Clinical practice guideline: Planning, initiating and withdrawal of renal replacement therapy. Available from www.renal.org

Development team

Director	Fergus Macbeth
Associate Director	Nicola Bent
Consultant Clinical Adviser	Tim Stokes
Lead Analyst	Charlotte Bee

• Topic expert group: chronic kidney disease

Field testing and consultation feedback

Consultation and field testing of the chronic kidney disease quality standard took place from 30 September to 10 December 2010. In total, 318 stakeholders were contacted during consultation and the NICE field team visited eight organisations to discuss the draft standard in detail. All eligible comments were reviewed by the Topic Expert Group and the standard was updated accordingly.

• Chronic kidney disease field testing and consultation report

Implementation support materials

• Cost impact and commissioning assessment
• Patient information
• Guide for commissioners: Early identification and management of chronic kidney disease in adults

Publication partners

Many organisations share NICE's commitment to improve quality by making it clear what quality care is for patients and the public, health and social care professionals, commissioners and service providers.

So that these standards reach the widest possible audience, some of the organisations who have been involved in the development process, and who endorse the chronic kidney disease quality standard, have become partners in its publication.

British Renal Society
The Kidney Alliance
The National Kidney Federation
Primary Care Cardiovascular Society
The Renal Association
Royal College of Physicians

Issued: March 2011