All stages – to include
• Regular clinical and laboratory assessment (see table overleaf) • Advice on smoking, weight, exercise, salt & alcohol intake • Cardiovascular prophylaxis: if risk >20% at 10 years consider - aspirin if BP 100 mg/mmol - include ACEI or ARB if urine PCR >100 mg/mmol or - if diabetes and microalbuminuria present + check creatinine and potassium - before starting and - 2 weeks after start and - after each dose change + if creatinine increases by >20% or GFR falls by >15% - repeat with potassium and seek advice (?stop ? test for RAS) • If potassium > 6 mmol/L - check no haemolysis and check diet - stop NSAIDs and LoSalt - stop K - retaining diuretics - stop ACEI/ARB if hyperkalaemia persists
List of sources of further information
This leaflet was prepared by Dr Steve Blades and Dr Richard Burden on behalf of the CKD Guideline Development Committee which included representatives from the Royal College of General Practitioners. The information is taken from ‘UK Guidelines for Identification, Management and Referral of Chronic Kidney Disease in Adults’; the full version and a concise version as well as electronic guidance are available at:
NSFs - Diabetes, Renal:
National Kidney Federation:
ACEI ARB BHS CKD ESA LoSalt NSAID PCR PTH RAS RRT SLE Angiotensin Converting Enzyme Inhibitor Angiotensin Receptor Blocker British Hypertension Society Chronic Kidney Disease Erythropoietin Stimulating Agent (Potassium containing salt substitute) Non Steroidal Anti inflammatory Drug Protein:Creatinine Ratio (best lab test for proteinuria) Parathyroid hormone Renal Artery Stenosis Renal Replacement Therapy Systemic Lupus Erythematosus
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