3 Managing chronic kidney disease (CKD)

3 Managing chronic kidney disease (CKD)

Modifying usual care

3.1 Think about how to modify usual care to reduce patient exposure to COVID‑19 and make best use of resources (workforce, facilities and equipment) while ensuring that services are available for patients.

3.2 When modifying individual patients' treatment plans:

  • take their preferences for care and treatment into account

  • take their clinical circumstances into account

  • involve all relevant members of the multidisciplinary team in the decision

  • record the reasoning behind each decision.

3.3 Discuss the risks and benefits of changing treatment schedules or interrupting treatment with patients.

Medicines

3.4 Advise patients to continue taking their medicines (including ACE inhibitors, angiotensin receptor blockers, immunosuppressants and diuretics) as normal, unless advised to stop by their healthcare professional. This includes patients who have symptoms of COVID‑19.

Be aware that there is no evidence from clinical or epidemiological studies that ACE inhibitors or angiotensin receptor blockers might worsen COVID‑19.

See:

3.5 For patients with CKD and suspected or confirmed COVID‑19, review the use of medicines, taking into account whether any have the potential to adversely affect renal function.

3.6 Prescribe usual quantities of medicines to meet the patient's clinical needs. Prescribing larger quantities of medicines puts the supply chain at risk.

Monitoring CKD

3.7 Reassess renal function in patients with CKD who have recovered from COVID‑19. Base the urgency of reassessment on the patient's GFR category, comorbidities and clinical circumstances.

3.8 For patients who are stable on treatment, assess whether it is safe to reduce the frequency of routine blood and urine tests during the COVID‑19 pandemic. Take into account any comorbidities and whether their CKD is progressive. (NICE's guideline on chronic kidney disease provides recommendations on the frequency of routine monitoring.)

3.9 Encourage self-monitoring and self-management (including blood pressure monitoring) for patients who are able to do this. Give them access to their medical data (including diagnosis, comorbidities, test results, treatments and correspondence) through information systems such as PatientView or primary care electronic records systems.

3.10 Ensure that patients who are self-monitoring or self-managing know when they should seek help and who to contact.