ckd presentation
TRANSCRIPT
![Page 1: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/1.jpg)
CKD for GPs
Dr Toni Munno
GP King Street Surgery, Kempston
![Page 2: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/2.jpg)
What does the ‘K’
stand for ??
Kardiovascular risk!
![Page 3: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/3.jpg)
![Page 4: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/4.jpg)
100
90
80
70
60
50
40
30
20
10
30-59 = CKD 3
15-29 = CKD 4
<15 or RRT = CKD 5
60-90 & abnormality = CKD 2
>90 & abnormality = CKD 1
eGFR & CKD
![Page 5: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/5.jpg)
How measure (e)GFR
Clever lab things etc
Formula = MDRD
creatinine, age, sex, race (black or other)
tables
Online calcFrom lab
![Page 6: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/6.jpg)
![Page 7: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/7.jpg)
![Page 8: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/8.jpg)
![Page 9: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/9.jpg)
100
90
80
70
60
50
40
30
20
10
30-59 = CKD 3
15-29 = CKD 4
<15 or RRT = CKD 5
60-90 & abnormality = CKD 2
>90 & abnormality = CKD 1
prevalence
3.3%
3.0%
4.3%
0.2%
0.2%
![Page 10: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/10.jpg)
Prevalence 2006/7
CKDNational prev 2.24%
Local prev 1.51%
Highest in Bedford4.75%
lowest in Bedford0.07%
x67
Eg list size 6000= 285 CKD pts
Eg list size 6000= 4 CKD pts
Work v. points!
![Page 11: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/11.jpg)
Why bother?
x30 – 60 higher all cause mortality x20 more likely to die from CVD than
progress to ESRF
10,000 pts
500 have CKD 3-5(20 = stage 410 = stage 5)
90% have BP
30% have DM
40% have Vasc dis
![Page 12: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/12.jpg)
http://www.rcplondon.ac.uk/pubs/books/CKD/CKDfullGuide.pdf
![Page 13: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/13.jpg)
![Page 14: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/14.jpg)
Step 1. Find them
![Page 15: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/15.jpg)
Screen..contd
![Page 16: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/16.jpg)
Step 2. Make the diagnosis
2 readings three months apart Use the right READ Codes
![Page 17: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/17.jpg)
Step 3. sort them out!
Who do I need to refer?
Need to know: at least
- Blood tests- Urine examination- BP
![Page 18: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/18.jpg)
Referal on basis eGFR
5
4
3
1, 2
4, 5 ref
3 +/-ref
![Page 19: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/19.jpg)
Referal for other reasons…
![Page 20: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/20.jpg)
Urine examination+ve for blood or protein MSU
Exclude infection
+ve for protein(more than a trace)
+ve for blood
Do PCR
>100
45-100
Ref Renal clinic
mAcro mIcromIcro
& protein
Urology2WR
mIcro NO protein
>50 <50
Neg? if egfr<60
![Page 21: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/21.jpg)
Step 4. review medication
![Page 22: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/22.jpg)
Step 5. sort out BP
TargetsWith protein 120/75
(threshold to start Rx is 130/80 if PCR >100, 140/90 otherwise)
Without protein 130/80QOF 140/85 !
Refer if >150/90 and on 3 antiBP rx
Remember 90% will have hypertension
![Page 23: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/23.jpg)
Step 6. should they be on ACEi ?
Yes – if proteinuria Yes – if no protein, as part combination Rx to
get to target Yes – if DM and microalbuminura
No – if no protein and already have good BP control in which case remember Read codes:
8I64 – ACE not indicated
8I6C - A2RB not indicated
BUT don’t exempt them from whole CKD domain!!
![Page 24: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/24.jpg)
![Page 25: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/25.jpg)
Monitoring ACEi
Check creatinine (eGFR) and K Before start medcn 2 weeks after starting 2 weeks after any dose change
Watch for creatinine increase >20%, eGFR decrease >15%If so: ‘repeat creatinine, check K, and refer for
specialist opinion on whether to stop rx or to investigate for renal artery stenosis.’
![Page 26: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/26.jpg)
Step 7. minimize cardiovascular risk
Lifestyle: smoke, wt, excse, alc, salt BP etc
‘If 10 yr CVD risk >20% consider’: Aspirin if BP < 150/90 Lipid lowering drug therapy
![Page 27: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/27.jpg)
Step 8. follow-up
Rem. flu & pneumo jabs
Stage 3 chronic disease model Check eGFR 6mthly
(12mthly if stable, ie < 2ml/min change over 6m) Annual check Hb, K, Ca, phosp BP
Stage 4,5 ?shared care Check eGFR 3mthly
(6mthly if stable CKD4) ? 3mthly bloods,
![Page 28: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/28.jpg)
![Page 29: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/29.jpg)
![Page 30: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/30.jpg)
QOF issues
Prevalence! Role of ACEi Appropriate use exemption codes
‘unsuitable/dissent’ , max tol, drugs
Prevalence of co-existing hypertension ?likely changes next year
![Page 31: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/31.jpg)
![Page 32: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/32.jpg)
Resources:
everything you need to know about CKD, eGFR , treatment and referral pathways can be found online:
www.renal.org
There is a very good recent update (April 2007) about CKD and QOF from NHS Employers and the BMA
FAQs for Chronic Kidney Disease (CKD). This document can be accessed at: -
www.pcc.nhs.uk/77.php
![Page 33: CKD presentation](https://reader035.vdocument.in/reader035/viewer/2022062303/556550bdd8b42a9b4c8b5172/html5/thumbnails/33.jpg)