Early diagnosis of CKD is important as it can help lower the risk of morbidity, mortality and associated healthcare costs. In 2009/10, the NHS spent £1.45 billion on CKD alone, with more than half of this going towards renal replacement therapy for the 2 per cent of people with CKD which progresses to kidney failure.
As the disease carries no symptoms it can often be hard to recognise, leading to late presentation. In addition, the way CKD has been previously classified has raised concerns that it may have been overdiagnosed in the past.
The updated guideline proposes a new system for classification of CKD, which takes into consideration recently published guidance by Kidney Disease: Improving Global Outcomes on the evaluation and management of chronic kidney disease.
NICE now recommends that CKD should be classified using a combination of glomerular filtration rate (GFR) and albumin:creatinine ratios (ACR) categories.
GPs should be aware that increased ACR or decreased GFR are associated with increased risk of adverse outcomes. In addition, increased ACR and decreased GFR in combination multiply the risk of adverse outcomes.
Elsewhere, the guideline recommends that testing for CKD using eGFRcreatinine and ACR should be offered to people with certain risk factors, which include AKI, diabetes, hypertension, heart disease.
NICE also recommends that patients who have had acute kidney injury 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 if serum creatinine has returned to normal levels.
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 seek to address the issues surrounding the correct diagnosis of CKD, and make sure that the right people get the right treatment for their condition.”
A series of algorithms have been produced that summarise the guideline and focus on classification and treatment.
Visit the NICE pathway on CKD for fast access to all that NICE recommends on the topic.