Do Not Do Recommendation

Do Not Do Recommendation Details

Recommendation:

Do not modify the renin–angiotensin system antagonist dose if the change in eGFR is less than 25% or the change in serum creatinine is less than 30%.

Interventions:

renin–angiotensin system antagonists

Source guidance details

Guidance:

Chronic kidney diseaseearly identification and management of chronickidney disease in adults in primary and secondarycare (CG182)

Published date:

July 2014

Paragraph number:

1.6.13

Page number:

32

View all NICE do not do from this Guidance

• Do not diagnose CKD in people with: an eGFRcreatinine of 45–59 ml/min/1.73 m2 and an eGFRcystatinC of more than 60 ml/min/1.73 m2 and no other marker of kidney disease.
• Do not use reagent strips to identify proteinuria unless they are capable of specifically measuring albumin at low concentrations and expressing the result as an ACR.
• Do not use urine microscopy to confirm a reagent strip positive result when testing for the presence of haematuria.
• Do not use age, gender or ethnicity as risk markers to test people for CKD.
• In the absence of metabolic syndrome, diabetes or Hypertension, do not use obesity alone as a risk marker to test people for CKD.
• Do not determine management of CKD solely by age.
• Do not offer low-protein diets (dietary protein intake less than 0.6–0.8 g/kg/day) to people with CKD.
• Do not offer a combination of renin–angiotensin system antagonists to people with CKD.
• Do not routinely offer a renin–angiotensin system antagonist to people with CKD if their pretreatment serum potassium concentration is greater than 5.0 mmol/litre.
• Do not routinely measure calcium, Phosphate, parathyroid hormone (PTH) and vitamin D levels in people with a GFR of 30 ml/min/1.73 m2 or more (GFR category G1, G2 or G3).
• Do not routinely offer vitamin D supplementation to manage or prevent CKD–mineral and bone disorders.