Chronic kidney disease assessment and management: updated guidance
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Chronic kidney disease assessment and management: updated guidance

Lynne Pearce Health journalist

Essential information

The term chronic kidney disease (CKD) describes abnormal kidney function or structure. It’s a common condition; about three million people in the UK have CKD, the charity Kidney Care UK says.

Nursing Standard. 36, 12, 11-11. doi: 10.7748/ns.36.12.11.s7

Published: 01 December 2021

CKD often occurs with other conditions, such as cardiovascular disease or diabetes, and risk factors include older age, family history of CKD, smoking, overweight, high blood pressure and a black, Asian or minority ethnic background.

Moderate to severe CKD is linked to increased risk of acute kidney injury, falls, frailty and mortality.

While CKD is usually asymptomatic, it is detectable with simple blood and urine tests. The National Institute for Health and Care Excellence (NICE) says there is evidence that treatment can prevent or delay the progression of CKD and complications, and reduce the risk of cardiovascular disease.

CKD is often unrecognised, or is only diagnosed at an advanced stage, when symptoms may include tiredness, swollen ankles, feet or hands, shortness of breath, feeling sick and blood in the urine.

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Picture credit: iStock

What’s new

In August, NICE updated its guidance on CKD. Covering the care and treatment of people with CKD, or who are at risk of the condition, it aims to prevent or delay its progression and reduce the risk of complications. It also covers the management of anaemia and hyperphosphataemia (a high level of phosphate in the blood) associated with CKD.

After the publication of new evidence, several areas have been updated, including investigations for CKD, classification, frequency of monitoring, blood pressure control, using phosphate binders to manage mineral and bone disorders, glomerular filtration rate for diagnosing anaemia and intravenous iron for treating anaemia.

How you can help your patient

Nurses can help patients manage their condition, reassuring them that many people with the condition live long lives without being unduly affected. Patients with mild CKD can try to prevent it from worsening and reduce the risk of other health problems.

Advise patients about maintaining a healthy and balanced diet, including changes such as limiting the amount of dietary potassium or phosphate where appropriate.

Regular physical activity, stopping smoking, limiting alcohol intake and receiving the annual flu vaccination and a one-off pneumococcal vaccination can also help. Patients may also need advice on managing medicines safely – for example, avoiding medicines, such as ibuprofen, which can reduce blood flow to the kidneys.

Patients with CKD should be monitored regularly and signposted to further support.

Expert comment

Aisling McMahon executive director of research, policy and innovation at Kidney Research UK

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‘We welcome this updated guidance. In particular, we’re pleased to see NICE advises the use of a new tool, the kidney failure risk equation (KFRE), which we helped to develop by providing research funding.

‘Using patient data to predict the risk of developing kidney failure within 2-5 years, the tool helps doctors and patients plan the best care pathway.

‘Key benefits include better personalisation of care by highlighting patients who need to be referred to hospital, the best time for their referral, and advance planning for more complex care.

‘We also welcome the removal of the recommendation to adjust for black ethnicity when estimating how well a patient’s kidneys are working, as this is no longer valid or accurate. We hope this will prevent overestimation of kidney function in people from black ethnic groups, enabling early treatment for CKD, but more research is needed.’

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