NICE overhauls CKD guideline

NICE has updated its clinical guideline on the diagnosis and treatment of chronic kidney disease (CKD) in adults.

CKD is common, frequently unrecognised and often exists together with other conditions such as cardiovascular disease and diabetes. | SCIENCE PHOTO LIBRARY
CKD is common, frequently unrecognised and often exists together with other conditions such as cardiovascular disease and diabetes. | SCIENCE PHOTO LIBRARY

The recommendations for the diagnosis, classification and management of CKD have changed significantly in the new guidance (CG182).

The grades of CKD previously specified have been replaced with two separate alphanumerical identifiers for renal function (GFR category G1-G5 with the same thresholds as the CKD stages 1-5 used previously) and level of albuminuria (ACR category A1-A3) derived from the Kidney Disease: Improving Global Outcomes Work Group.

Prescribers should now classify CKD using a combination of these GFR and ACR categories and should be aware that increased ACR or decreased GFR are both associated with an increased risk of adverse outcomes, and the combination of increased ACR and decreased GFR multiplies the risk of adverse outcomes.

Patients with CKD who require treatment with an antihypertensive can now be offered any low-cost renin-angiotensin system antagonist, including a first-line ACE inhibitor (as previously recommended), an angiotensin II receptor antagonist or the direct renin inhibitor aliskiren.

The guideline also provides advice on patient self-management, recommending that patients are provided with information about exercise, diet and lowering their blood pressure.

The new guidance "will enable doctors to make the correct diagnosis of CKD, and make sure that the right people get the right treatment for their condition," according to Professor Mark Baker, Director of the Centre for Clinical Practice at NICE.

A quick-reference MIMS summary of the new guideline will appear in MIMS in due course.


MIMS Clinics

Prescribing news and resources for key therapeutic areas, collated by the MIMS editors.

Register or Subscribe to MIMS

GPs can get MIMS print & online and GPonline for free when they register online – take 2 minutes, and make sure you get your free MIMS access! If you're not a GP, you can subscribe to MIMS for full access.

Register or subscribe

MIMS bulletins

News and updates straight to your inbox.

Prescribing Update: Fortnightly news bulletin
Alert:
Urgent prescribing updates
Spotlight: Disease-themed monthly round-up

Sign me up

MIMS Dermatology

Read the latest issue online exclusively on MIMS Learning.

Read MIMS Dermatology

Mobile apps

MIMS: access the full drug database and quick-reference tables on the go

MIMS Diagnosis and Management: concise information on signs and symptoms, investigations and diseases

Promo Image

Clinical calculators

Handy calculators and conversions for primary care.