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.