Particular methods and tests for diagnosing chronic kidney disease (CKD)[1] should be consistently used across England and Wales to ensure people with the condition benefit from the right diagnosis and treatment.

The National Institute for Health and Care Excellence (NICE) has updated its guidance on the diagnosis and treatment of CKD. This comes after a review of current evidence.

CKD is a long-term condition where the kidneys do not work efficiently. It is common, affecting up to 1 in 10 people. It is an illness that often exists alongside other conditions (such as cardiovascular disease and diabetes). It should not be confused with acute kidney injury[2].

Moderate to severe CKD is also associated with an increased risk of other significant problems such as acute kidney injury, falls, frailty. There is also a risk of death.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “Chronic kidney disease often has no symptoms so can go undetected, potentially leading to serious health problems. Late presentation of people with kidney failure increases sickness and death and costs the NHS more. Figures suggest chronic kidney disease costs the NHS in England between £1.44 and £1.45 billion every year. These updated recommendations will enable doctors to make the correct diagnosis of CKD, and make sure that the right people get the right treatment for their condition.”

NICE is recommending that people are tested for CKD by checking chemical markers in the blood using tables to determine when a person should be diagnosed.

There have been concerns that CKD may have been over-diagnosed in the past. The updated guideline makes recommendations which will reduce the number of people being diagnosed and treated.

The guideline also makes recommendations on how people can manage their own condition. It recommends people are provided with information about exercise, diet and lowering their blood pressure.

According to the updated guidance people who have had an acute kidney injury (AKI) should be warned that they are at increased risk of developing CKD and should be monitored for at least 2-3 years after the AKI, even when their kidney function returns to normal.

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For more information call the NICE press office on 0845 003 7782 or out of hours on 07775 583 813.

Notes to Editors

The chronic kidney disease guideline is available online. Alternatively contact the press office for a copy.

Explanation of terms

1. Chronic kidney disease (CKD) is a long-term condition where the kidneys do not work effectively. CKD does not usually cause symptoms until reaching an advanced stage. It is usually detected at earlier stages by blood and urine tests. Main symptoms of advanced kidney disease include:

• tiredness
• swollen ankles, feet or hands (due to water retention)
• shortness of breath
• nausea
• blood in the urine

1. CKD is increasingly recognised as a public health problem and there is considerable overlap between CKD, diabetes and cardiovascular disease, therefore requiring management by multidisciplinary teams. The risk of developing CKD increases with increasing age. 
2. The classification of CKD has evolved over time. In 2004, the Department of Health’s National service framework for renal services adopted the 2002 US National Kidney Foundation Kidney Disease Outcomes Quality Initiative classification of CKD. This classification divides CKD into 5 stages and uses the combination of an index of kidney function, the glomerular filtration rate (GFR), and markers of kidney damage to define the stages. Stages 3–5 were defined by a GFR less than 60 ml/min/1.73 m² with or without markers of kidney damage, on at least 2 separate occasions separated by a period of at least 90 days. Stages 1 and 2 were defined by the presence of markers of kidney damage including albuminuria, urine sediment abnormalities, electrolyte and other abnormalities caused by tubular disorders, abnormalities detected by histology, structural abnormalities detected by imaging and a history of kidney transplantation.

Acute kidney injury

1. Acute kidney injury (AKI) is sudden damage to the kidneys that causes them to stop working properly. It can range from minor loss of kidney function to complete kidney failure. AKI is common and normally happens as a complication of another serious illness. It is not the result of a physical blow to the kidneys, as the name may suggest.
2. In the early stages of AKI, there may not be any symptoms. The only possible warning sign may be that the person isn't producing much urine, although this isn't always the case. However, someone with AKI can deteriorate quickly and suddenly experience any of the following:

• nausea and vomiting
• dehydration
• confusion
• high blood pressure
• abdominal pain
• slight backache
• a build-up of fluid in the body (oedema)

      3. Even if it doesn't progress to kidney failure, AKI needs to be taken seriously, as it has an effect on the whole body and can make some existing illnesses more serious.

AKI differs to chronic kidney disease, where the kidneys gradually lose function over a long period of time.