guide to resources
TRANSCRIPT
NICE guide to resources: Chronic Kidney Disease 2nd Edition 2010 1 of 32
Chronic kidney disease
Guide to resources
Implementing NICE guidance
2nd Edition
2010
NICE clinical guideline 73
This guide to resources accompanies the clinical guideline: ‘Chronic kidney
disease: early identification and management of chronic kidney disease in
adults in primary and secondary care’ (available online at:
www.nice.org.uk/CG073).
Issue date: 2010
Review date: October 2011
This is a support tool to help guide people to resources that may support the
implementation of NICE guidance.
It is not NICE guidance.
NICE is not responsible for the quality or accuracy of any information or
advice provided by other organisations.
National Institute for Health and Clinical Excellence
MidCity Place, 71 High Holborn, London WC1V 6NA; www.nice.org.uk
© National Institute for Health and Clinical Excellence, 2010. All rights reserved. This
material may be freely reproduced for educational and not-for-profit purposes. No
reproduction by or for commercial organisations, or for commercial purposes, is
allowed without the express written permission of NICE.
NICE guide to resources: Chronic Kidney Disease 2nd Edition 2010 2 of 32
Contents
Contents...........................................................................................................3
Introduction.......................................................................................................4
Resources from NICE.......................................................................................5
The guideline....................................................................................................5
Supporting implementation...............................................................................5
Government strategy and policy documents....................................................7
Prevalence......................................................................................................10
Useful calendar events...................................................................................10
Classification..................................................................................................13
Patient information and education..................................................................14
Resources for primary care practitioners........................................................17
Lifestyle advice...............................................................................................24
Pharmacotherapy...........................................................................................25
International resources...................................................................................26
Related NICE guidance..................................................................................27
Feedback........................................................................................................29
Sending us feedback......................................................................................29
Acknowledgements........................................................................................30
NICE guide to resources: Chronic Kidney Disease 2nd Edition 2010 3 of 32
Introduction
NICE has produced this guide to help people involved in putting the NICE
guideline on chronic kidney disease (CKD) into practice. Chronic kidney
disease is a common and frequently unrecognised condition affecting
approximately 1 in 10 of the population. CKD often exists together with other
conditions, including cardiovascular disease and diabetes and when
advanced, carries a higher risk of mortality.
It highlights a selection of resources available from NICE, government and
other national organisations, which can be used alongside the NICE guides
‘How to put guidance into practice’, ‘How to change practice’ and How to use
NICE guidance to commission high-quality services
The recommendations in the NICE guideline are aimed at a range of different
audiences, including primary and secondary NHS healthcare, and referral to
tertiary care. This guide is for people responsible for implementing the
guideline in each of the relevant settings.
NICE has developed this guide in consultation with key stakeholders and
experts in the area, and it has been tested by potential users of the guide (see
acknowledgements). It has been designed to provide an overview of
information directly related to the guideline, but it is not an exhaustive list.
NICE is not responsible for the quality or accuracy of, and does not endorse,
any information or advice provided by other organisations that is linked to in
this document. It should be noted that many documents and resources
included within this guide were published prior to the NICE guideline on CKD.
Hyperlinks take you directly to the resource. These hyperlinks were correct at
the time of publication; if they no longer work because changes have been
made to external websites, you should visit the relevant home page to search
for the document.
NICE guide to resources: Chronic Kidney Disease 2nd Edition 2010 4 of 32
Resources from NICE
The guideline
You can download the guideline documents from www.nice.org.uk/CG073
The NICE guideline – all the recommendations.
The full guideline – all the recommendations, details of how they were
developed, and summaries of the evidence they were based on. This is
produced by the National Collaborating Centre commissioned by NICE to
work on this guideline.
A quick reference guide – a summary of the recommendations for
healthcare professionals.
Understanding NICE guidance – information for patients and carers.
Supporting implementation
Implementation tools
NICE has developed tools to help organisations implement the clinical
guideline on CKD (listed below). These are available on our website
(www.nice.org.uk/CG073).
Costing tools:
costing report to estimate the national savings and costs associated with
implementation
costing template to estimate the local costs and savings involved.
Slides highlighting key messages for local discussion.
Audit support for monitoring local practice.
How to put NICE guidance into practice
A practical guide to help organisations implement NICE guidance and other
national policies, ‘How to put guidance into practice: a guide to
implementation for organisations’ is also available to download from the NICE
website.
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How to change practice
A guide to help managers and clinicians influence changes in practice, ‘How
to change practice: understand, identify and overcome barriers to change’, is
also available. It provides practical suggestions based on evidence and
experience to help put NICE guidance into practice.
How to put NICE guidance into practice and improve the health and
wellbeing of communities: practical steps for local authorities
This guide is for chief executives, their senior officers and others within local
authorities who lead on different aspects of health and wellbeing.
How to use NICE guidance to commission high-quality services
This guide aims to support people involved in commissioning health and
social care services and public health programmes in developing systems and
processes that embed NICE guidance into commissioning, is also available.
ERNIE
The ERNIE (Evaluation and review of NICE implementation evidence)
database is a source of information on the implementation and uptake of
NICE guidance. It includes internal reports on the uptake of NICE guidance,
classifies whether practice is in line with the guidance and describes external
literature on the implementation of the guidance.
Shared learning database
Have you got some tips to share with other organisations on how you have
implemented aspects of the guidance within your clinical practice?
The shared learning database gives examples of good practice from the NHS
and partner organisations. If you would like to learn from other peoples’
experiences or share your own experience of implementing this guideline with
others, please visit the shared learning database on our website. All
submissions will be entered for the annual NICE Shared learning award.
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Government strategy and policy documents
Document RelevanceKey National Service Framework documents
Department of Health (2004) National service framework for renal services: part one – dialysis and transplantation. London: Stationery Office.
Available from: www.dh.gov.uk
This NSF provides a background on the service delivery standards and markers within existing renal services, and includes a section on markers related to patient-centred care.
Department of Health (2005) National service framework for renal services – part two: chronic kidney disease, acute renal failure and end of life care. London: Stationery Office.
Available from: www.dh.gov.uk
This National Service Framework (NSF) considers measures that can be taken, including within primary care, to help prevent the development of CKD, or to slow down the progression of kidney damage when a diagnosis has been made.It outlines the national steps the NHS can take in the current planning cycle to support delivery of the standards and markers of good practice and to improve services.
The NSF should be used to agree and inform regional service configuration and delivery plans. Useful sections include:
a care pathway for CKD
CKD prevalence
quality requirements on prevention and early detection of CKD and minimising the progression and consequences of CKD.
Department of Health (2009)
End of Life Care in Advanced Kidney Disease. A framework for implementation.
Available from:
www.dh.gov.uk
This framework outlines the importance of how commissioners and clinicians can work with patients and carers to ensure that people with advanced kidney disease receive the very best care in their end of life.
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Document Relevance
Related National Service Framework documents
Department of Health (2009)
Achieving Excellence in Kidney Care - Delivering the NSF for Renal Services
Available from: www.dh.gov.uk
This report highlights progress over the five years since the publication of the National Service Framework
Department of Health (2008) Delivering the 18 week patient pathway. Chronic kidney disease.
Available from: www.18weeks.nhs.uk
This resource provides information to support the implementation of the 18 week commissioning pathway for CKD.
It outlines clear responsibilities for commissioners and delivery of services for CKD.
It also has links to service improvement tools and techniques, along with a CKD interactive pathway.
Department of Health (2009)
QOF Business Rules version 16.0. Primary Care ContractingAvailable from:www.primarycarecontracting.nhs.ukwww.pcc.nhs.uk
This document outlines the technical requirements for correctly recording QOF information on CKD indicators.
Department of Health ( February 2008)Driving service improvement through patient focus: report of the phase II Renal Action Learning Sets 2006-2007
Available from:http://www.dh.gov.uk
In 2006/07, the Department of Health’s Renal NSF Team funded Phase II of the Renal Action Learning Set programme. This report summarises the work of the 6 learning sets established to address the year before renal replacement therapy and the transition from paediatrics to adult services and acute kidney injury.
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Document Relevance
Related National Service Framework documents (continued)
Department of Health (2007) Second progress report on the renal NSF.
Available from: www.dh.gov.uk
This report reviews renal service improvements in England between late 2005 until early 2007. There is a particular focus on radical changes to the service, such as improved facilities and prevention and early detection of CKD.
The document includes examples of good practice in service delivery and may be a useful tool for local implementation teams.
Department of Health (2005) Renal services information strategy: supporting part two of the national service framework for renal services . London: Stationery Office.
Available from: www.dh.gov.uk
This document complements the ‘NSF for renal services – part two: chronic kidney disease, acute renal failure and end of life care’. Its aim is to support the implementation of the quality requirements of the NSF and ensure there is appropriate information for patients, families and carers, the public and healthcare professionals.
Department of Health (2004) National Service Framework for renal services: glossary of terms for part one: dialysis and transplantation and part two: chronic kidney disease, acute renal failure and end of life care.
Available from: www.dh.gov.uk
This is a clear and comprehensive glossary of the terms used in the NSF for renal services part one and part two. NSF part one refers to dialysis and transplantation, and NSF part two to CKD, acute renal failure and end of life care.
It is a useful and succinct summary of terms used in the two renal NSFs.
Department of Health (2004) The National Service Framework for renal services Part 1: dialysis and transplantation – implementation toolkit for commissioners.
Available from: www.dh.gov.uk
This practical toolkit gives advice, guidance and support for commissioners implementing the ‘NSF for renal services: part one – dialysis and transplantation’ and developing local service strategies.
This resource will be of use to commissioners of renal secondary care services.
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Prevalence
Resource Relevance
The Association of Public Health Observatories – chronic kidney disease prevalence estimates
Available from: www.erpho.org.uk
Chronic Kidney Disease (stages 3-5) prevalence estimates using data from the Neoerica study.
CKD prevalence by age, sex and region in 2008
Available from:
www.erpho.org.uk
Chronic disease prevalence using the QOF business rules applied to The Health Improvement Network (THIN) database. This MSExcel spreadsheet covers ten conditions, including CKD, each on separate tabs.
QOF Achievement and Prevalence Bulletin 2008-09 FinalFF.doc
Available from:
www.ic.nhs.uk
This document provides a comprehensive overview at a national level of QOF performance. It includes prevalence data for CKD
East Midlands Public Health Observatory
The East Midlands Public Health Observatory is the lead Public Health Observatory for renal health. They provide information resources on renal disease and services. EMPHO also collaborated with the UK Renal Registry on production of the interactive maps (for 2006) Some parts of the site require registration.
Useful calendar events
Event Relevance
World Kidney Day UK
World kidney day
Accessed via:
www.worldkidneyday.org
An annual awareness raising event, taking place on the second Thursday of March.World Kidney Day is a joint initiative organised by the members of the International Society of Nephrology and the International Federation of Kidney Foundations, and it is supported in the UK by members of the Kidney Alliance. It aims to raise awareness of the importance of the kidneys and to spread the message that kidney disease is common, harmful and treatable.
British Renal Society annual conference
Accessed via:
www.britishrenal.org
Held in the second quarter of the year, the annual British Renal Society annual conference is for renal professionals within the UK.
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Investigation
Early identification and measurement of kidney function
Document Relevance
Crowe E, Halpin D, Stevens P. Early identification and management of chronic kidney disease: summary of NICE guidance. BMJ 2008; 337: a1530.
Available from:www.bmj.com
This article was produced by members of the NICE CKD Guideline Development Group. It summarises the recommendations from the NICE guideline on CKD which includes guidance on the effective means of identifying people who have or are at risk of developing CKD.
NHS Evidence (2008)
Kidney diseases specialist library. Proteinuria and eGFR national knowledge week – characterisation and description of urinary protein excretion in health and in disease.
Available from: www.evidence.nhs.uk
This technical reference may be particularly useful to GPs who are implementing the NICE clinical guideline on CKD.
It outlines how testing can identify potential adverse renal and cardiac outcomes in patients.
This resource was published with reference to the draft NICE clinical guideline on CKD. The final, revised NICE guidance has since been published and some of the recommendations referenced in the ‘Kidney diseases specialist library’ have now changed, including recommendation 1.1.4.2 on how to detect proteinuria.
Department of Health (2009)Proteinuria: detection and quantitation in adults using ACR- information for laboratories.
Available from:www.dh.gov.uk
This publication contains information sheets produced for laboratories, and for GPs. It summarises the benefits of using ACR, and provides practical guidance on its use.
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Document RelevanceDepartment of Health (2006) Estimating glomerular filtration rate (eGFR): frequently asked questions.
Available from: www.dh.gov.uk
The NSF for renal services recommended that local health organisations work with pathology services and networks to develop protocols for measuring kidney function by serum creatinine concentration together with a formula-based estimation of glomerular filtration rate (GFR), calculated and reported automatically by all clinical biochemistry laboratories.
This is a good source of clear and concise answers to frequently asked questions about eGFR (estimated GFR).
Department of Health (2006). Estimating glomerular filtration rate (eGFR): Information for general practitioners.
Available from: www.dh.gov.uk
This information sheet advises GPs on how to implement eGFR reporting nationally.
It is a good source of clear, concise information.
Department of Health (2006) Estimating glomerular filtration rate (eGFR): Information for laboratories.
Available from: www.dh.gov.uk
This information sheet is aimed at clinical laboratory practitioners, to help them coordinate implementation and harmonise the reporting of GFR nationally.
It is a good source of clear, concise information.
National Kidney Foundation (2002) K/DOQI Clinical practice guidelines for chronic kidney disease: guideline 4. Estimation of GFR.
Available from: www.kidney.org
The American KDOQI guideline is a useful source of background information on CKD.The section linked to here has a detailed overview of the estimation of GFR (eGFR) and is from a wider section of the guideline on the evaluation of laboratory measurements for clinical assessment of kidney disease.
Published six years before the NICE guideline on CKD, it contains areas inconsistent with the recommendations in the NICE guidance.
These include:
the NICE guideline on CKD recommends using the MDRD (modification of diet in renal disease) equation to estimate GFR rather than the Cockroft Gault formula
the classification of CKD into five stages; the NICE guideline on CKD updates this classification by recommending stage 3 is split into two categories: 3a and 3b.
This resource should be read in conjunction with the NICE quick reference guide on CKD or the NICE guideline on CKD.
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Classification
Document RelevanceRoyal College of Physicians of Edinburgh (2007) UK consensus statement
Available from: www.rcpe.ac.uk
This UK-wide consensus statement on early chronic kidney disease was published at the conclusion of a conference in February 2007 and includes a number of recommendations aimed at improving the detection, classification, treatment and organisation of care for this condition; including the recommendation to split CKD stage 3 into two groups, 3a and 3b.
National Kidney Foundation (2002) Chronic kidney disease: evaluation, classification and stratification
Available from: www.kidney.org
This is a useful reference resource on CKD classification.
The KDOQI guidelines were published six years before the current NICE guideline on CKD. There are a number of inconsistencies between the National Kidney Foundation resource and the NICE guidance, including:
classification of CKD into five stages; the NICE guideline on CKD updates this classification by recommending stage 3 is split into two categories: 3a and 3b
Methods of investigation for detecting proteinuria; the NICE guidance clearly outlines recommended methods, which should be adhered to.
This resource should be read in conjunction with the NICE quick reference guide on CKD or the NICE guideline on CKD.
CKD EPI & MDRD GFR Calculator
Available from:
www.mdrd.com
This website hosts a 4 variable MDRD CKD EPI Equation (with SI Units) using standardized serum creatinine, age, race, gender. This is potentially useful, perhaps more so to secondary care. It allows a ready comparison of the eGFRs generated using non-IDMS creatinine, IDMS creatinine, and CKD-Epi
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Patient information and education
Resource RelevanceMedical information folder - CKD
Available from:
www.kidney.org.uk
This provides a range of useful information. It begins by emphasising the true meaning of “chronic”, which is helpful.
Patient UK /EMIS (2008)
Chronic Kidney Disease - A SummaryAvailable from: www.patient.co.uk
An online article from PatientPlus, using the same sources of information as that provided to GPs via EMIS. The article also links to a contains some technical language, but it may provide a useful source of more detailed information for some patients.
Diabetes and high blood pressure; two leading causes of kidney disease(2008)
Available from:
www.nkdep.nih.gov
A concise American resource for patients which outlines that early kidney disease may show no visible signs or symptoms.It explains the rationale for testing and early detection of CKD.
Kidney research UK (2008) Kidney disease education and prevention programme in African Caribbeans. (ABLE leaflet)
Available from:
www.kidneyresearchuk.org
A concise awareness raising leaflet about kidney disease targeting the African Caribbean communities, produced by the ABLE project.
Information about kidney diseases for patients and others – EdRenINFO.
Available from:
www.renux.dmed.ed.ac.uk/EdREN/
This section of the Scottish website provides useful general information on kidney diseases for both patients and doctors who are not renal specialists. Topics are listed alphabetically via an a-z index.
It should be noted that as Scotland are covered by separate guidelines to England some of the information provided may not be consistent with the recommendations within the NICE guideline. It is recommended that this site is used in conjunction with the CKD Understanding NICE Guidance resource.
Department of Health (2009)
Identifying unhealthy kidneys: what do I need to know about proteinuria? Information for patients
Available from:
www.dh.gov.uk
This leaflet, aimed at patients, explains the meaning and signs of proteinuria, along with the tests to determine proteinuria. It also covers how to manage diabetes and high blood pressure with proteinuria.
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Resource RelevanceNHS Choices website This NHS patient information website aims to help people make
informed decisions about their healthcare.It helps people make choices about their health, from lifestyle decisions about smoking, drinking and exercise, to the practical aspects of finding and using NHS services when they need them.
It draws together information from the NHS Evidence, NHS Direct, the Information Centre for Health and Social Care, the Care Quality Commission, and many other organisations.
NHS Choices (2007/8) Kidney disease: an introduction.
Chronic kidney disease
Kidney failure
Available from: www.nhs.uk
Three videos available for view or download from NHS Choices
Kidney disease: an introduction
Kidney specialist nurse Nicola Thomas talks about the five stages of chronic kidney disease and the treatments
An introduction, overview of causes, diagnosis, risks, treatment and prevention of kidney failure. It is also possible to access a real life patient story.
Kidney Research UK (2008)
Living with Kidney disease. Module 1 y 2
Available from:
www.kidneyresearchuk.org
These DVDs provide information to patients to enable them to make choices about their lifestyle and, if necessary, treatment plans. Module one is a health awareness educational DVD to support healthcare practitioners in promoting the best quality of life for their patients whether they are at risk of CKD, in the earlier stages or approaching end stage renal failure.
Module two focuses on acute and end stage renal failure using the experiences of patients, carers, renal units and clinicians to help patients to gain understanding of the reality of living with kidney disease.
The DVDs include options to view with subtitles in English and audio in English, Bengali, Gujurati, Urdu and Punjabi.
DVD may be ordered.
National Kidney Disease Educational Programme (NKDEP) (2009)
Available from:
http://www.nkdep.nih.gov/professionals/providereducation/index.htm
NKDEP is a US Department of Health & Human Services initiative that has developed a series of short videos that show possible approaches health professionals can use to explain different aspects of CKD (risk, testing and diagnosis, treatment and dialysis and transplantation) to patients. Note that these resources do not use the NICE stages of CKD.
NHS Renal PatientView (portal)
This secure NHS site allows renal patients to view their test results and access details regarding their local clinic. PatientView is only available from some UK renal units, and for patients who have chosen to participate. There is a list of units involved so far. The information comes directly from existing databases within units,
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Resource RelevanceUK National Kidney Federation
This comprehensive national UK website is run by people living with CKD and other renal conditions. It promotes good practice in renal medical treatment, and provides information for people affected by CKD or established renal failure. It also has a useful links page where there is specific information for patients and carers, other UK Renal Unit websites, and organisations related to kidney diseases.
Kidney disease blog
From NHS Choices
People with kidney disease discuss their symptoms, treatment and even their transplants and try to help others with similar conditions. The views expressed in the blog are personal, not those of the NHS, but offer a space for people living with and carers of those with kidney conditions to tell their stories, difficulties and triumphs.
Kidney Research UK This national UK charity funds research on prevention, treatment and management of kidney disease as well as focussing on improving patient care and raising awareness of kidney disease.
East Midlands Renal Network: Patient resources
This website from the East Midlands Renal Network aims to deliver user-friendly advice and information on topics from how your kidney works through to kidney transplants. Useful areas for patients may include: your kidneys; are you at risk of kidney disease; facts, figures and FAQs; what is kidney disease?; diabetes and blood pressure; what can I do; and a seasonal Christmas potassium dietary advice page.
National Kidney Foundation
The American National Kidney Foundation works to raise awareness to prevent kidney and urinary tract diseases, and improve the health and well-being of individuals and families affected by kidney disease.
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Resources for primary care practitioners
Resource RelevanceNHS Employers (2010)
Chronic Kidney Disease - FAQs
Available from:
www. nhsemployers .org
also available at
www.bma.org.uk
NHS Employers and the General Practitioners Committee (GPC) of the British Medical Association (BMA) have published these frequently asked questions (FAQs) in response to queries received from primary care organisations and practices, in relation to the diagnosis and management of chronic kidney disease following its inclusion in the Quality and Outcomes Framework (QOF) in 2006. The updated FAQs were published in January 2010.
Department of Health (2008 to date)
NHS Health Check policy documents
NHS Health Check resources for NHS staff
Available from: www.dh.gov.uk
The NHS Health Check programme aims to help prevent heart disease, stroke, diabetes and kidney disease. Everyone between the ages of 40 and 74, who has not already been diagnosed with one of these conditions, will be invited (once every five years) to have a check to assess their risk of heart disease, stroke, kidney disease and diabetes and will be given support and advice to help them reduce or manage that risk. Implementation of the programme will be phased and the full implementation is expected by 2012/13.
These separate webpage provide policy background and resources for this major initiative.
UK Renal Registry
Available from:
www.renalreg.com
The UK Renal Registry is a resource for the development of patient care in renal disease. This resource provides independent, professionally led, audit and analysis of renal replacement therapy (RRT) in the UK.It also details the incidence and prevalence of CKD in the UK, contains annual reports for commissioners of renal services and interactive geographical maps of the UK.
Cassidy M, Richardson D, Jones C (2007) Complications of CKD. UK Renal Association Clinical Practice Guidelines.
Available from: www.renal.org
The Renal Association published this comprehensive guideline and set of audit measures in 2007. It is currently being revised and it is expected to be completed in 2010.
Taal M, Tomson C (2007) Clinical practice guidelines for the care of patients with chronic kidney disease. UK Renal Association clinical practice guidelines.
Available from: www.renal.org
This comprehensive guideline and set of audit measures for detecting, monitoring and referring patients with CKD is currently being revised and it is expected to be completed in 2010 to take account of the NICE guideline on CKD.
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Resource Relevance Anderson J, Fawcett D et al. (2008). A consensus statement of the initial assessment of haematuria guideline.
Available from: www.renal.org
A consensus statement of the initial assessment of haematuria
The review highlighted the lack of high quality studies and unanswered questions relevant to clinical care. As a consequence, the Renal Association (RA) and British Association of Urological Surgeons (BAUS) formed a joint working party to agree joint guidelines to help inform health care professionals and commissioners caring for patients presenting with haematuria. These guidelines are for the management of haematuria once detected.
Klebe B, Cooley R, et al. (2008)
An expert renal system to identify and manage chronic kidney disease in the community Renal Unit, Kent and Canterbury Hospital.Available from: www.kentrenal.org
This paper outlines the principles of the New Opportunities for Early Renal Intervention system (NEOERICA), which is a structure for identifying people with CKD from general practice computer records.
Algorithms
Decision algorithm for the investigation and referral of haematuria
Available from:www.renal.org
A useful algorithm on the approach to microscopic haematuria, available (page 5) within this Consensus Statement for the Initial Assessment of Haematuria
Diagnosis and referral of patients with diabetes and chronic kidney disease
Available from:www.nice.org.uk
This algorithm forms an appendix to the full clinical guideline and maps the diagnosis and referral of patients with diabetes and chronic kidney disease
Diagnosis and referral of patients with chronic kidney disease and without diabetes
Available from:www.nice.org.uk
This algorithm forms an appendix to the full clinical guideline and maps the diagnosis and referral of patients with chronic kidney disease and without diabetes
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Resource RelevanceKnowledge aids
Map of medicine clinical pathway
Pathway for acute renal failure and chronic kidney disease. (2009)
Available from: www.mapofmedicine.com
Map of Medicine (MoM) requires registration to view all the pathways. However, NHS Choices enables a view of the patient MoM pathway for acute renal failure, chronic kidney disease and renal replacement therapy.
NHS Institute for innovation and improvement (2008)
Focus on: preparing for end-stage renal disease
Available from:
www.institute.nhs.uk
This project identifies clinical pathways and processes that give renal patients easier, more efficient access to their chosen treatment option. Registration is required before downloading the document.
NHS Clinical Knowledge SummariesAvailable from: www.cks.library.nhs.uk
NHS Clinical Knowledge Summaries (formerly PRODIGY) is a source of evidence-based information and practical ‘know how’ about many common conditions managed in primary care.
It includes the CKD-related unit of ‘Diabetes Type 1 and 2 – screening/managing renal disease’.This covers:
background information on the condition
making a diagnosis
management
evidence
drugs in this topic
leaflets for patients
Knowledge Plus’
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Resource Relevance
Knowledge aids (continued)
NHS Kidney Care: Whatworks-Shortfilms
Available from:
www.kidneycare.nhs.uk
Six short films covering - “Acute Kidney Injury”- focusing on the recommendations
made by the NCEPOD report into AKI, and looks at work being carried out at Chelsea and Westminster Hospital to ensure that AKI is swiflty diagnosed and treated.
“Peritoneal Dialysis - greater freedom of choice” - exploring the benefits of Peritoneal Dialysis, and talks to a clinician and patients at St Helier Hospital, which routinley offers patients the choice of assisted APD.
“End of Life Care in Advanced Kidney Disease” - looking at conservative care management for patients with advanced kidney disease, focusing on the work carried out by the chronic renal failure team at Wolverhampton's New Cross Hospital.
Empowering Kidney Patients Through Self Care The role of primary care in managing early symptoms of
CKD Home haemodialysis
The Information Centre for Health and Social Care (2009)
National Renal Dataset “Improving Kidney Care through Information ”
Available from: www.ic.nhs.uk
The National Renal dataset provides specific information to be collected by the NHS to support implementation of the National Service framework for Renal Services. The information can be used by kidney care services to assess their achievement of the quality standards and to improve kidney care for patients.
The Information Centre for Health and Social Care (2009)
National Kidney Care Audit
Available from: www.ic.nhs.uk
The National Kidney Care Audit is the latest clinical audit that the Healthcare Commission has commissioned the NHS Information Centre to provide. Delivered throughout the National Clinical Audit Support Programme (NCASP), the audit will help identify the best ways to improve renal services. As well as all adults receiving haemodialysis, the audit also covers children and young people.
NHS National Specialised Commissioning Group
Specialised renal services (adult).2009
Available from:
www.nscg.nhs.uk
The Specialised Services National Definition Set consists of 35 definitions. It was drawn up by a process involving providers (clinicians, hospital managers, and information and coding staff), commissioners and patients’ groups and is then endorsed wherever possible by relevant national organisations.
One of these definitions is for “specialised renal services (adult) whose is to identify the activity that should be regarded as specialised and therefore within the remit of PCT collaborative commissioning. The definitions provide a helpful basis for service reviews and strategic planning and enable commissioners to make comparisons on activity levels and spend. The definitions assist in the identification of activity that should be regarded as specialised.
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Resource Relevance
Educational packages
Chronic kidney disease: early identification and management in adults - in association with NICE
Available from:
www.learning.bmj.com
This free interactive resource uses case histories and guides learners through real life consultations.
After completing this module users should know:
When to suspect that a patient has or is at risk of developing chronic kidney disease
Which patients need intervention to minimise cardiovascular risk and what that intervention should be
Which patients are likely to develop progressive kidney disease and/or complications of kidney disease and how they can be managed
Which patients need referral for specialist kidney care.
and be able to:
Challenge misconceptions about the guidelines on diagnosing and managing chronic kidney disease
Apply this knowledge in your practice
Reflect and compare your own practice against recommended audit criteria
Registration is needed for access.
British Renal Society and OCB Media (2008) Chronic Kidney Disease - A Guide for Primary Care
Available from:
www.ckdonline.org
An advanced online educational resource developed by OCB Media in collaboration with the CKD Forum of the British Renal Society. It focuses on the changing management of CKD as a result of the recent reclassification of Chronic Kidney Disease, introduction of QOF CKD indicators and the publication of NICE guidance.
Registration is needed for access.
Warwick Kidney Care
Available from:www.warwick.ac.uk
This educational programme from Warwick Medical School and the Renal Association aims to help GPs and practice nurses implement the UK guidelines for identification, management and referral of CKD and to achieve the Quality and Outcomes framework targets for CKD. Registration details can be found via the course webpage.
CKD Postgraduate courses
Available from:www.warwick.ac.uk
Three short courses offered by Warwick Medical School covering different aspects of CKD, that are designed to allow a very high level of flexibility
British Medical Journal (2007) Practice: 10 - minute consultation: chronic kidney disease. 334:1273
Available from: www.bmj.com
This is a free access, electronic clinical update module which is part of a series of occasional articles on common problems in primary care from the BMJ.
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Resource Relevance
Quality improvement initiatives
Kidney Research UK: quality improvement in chronic kidney disease
Available from: www.kidneyresearchuk.org
This national study on quality improvement in CKD was funded by the Health Foundation. It aims to develop, implement and evaluate a range of quality improvement interventions in CKD in primary care.
Kidney Disease Modernisation Initiative (KDMI)
Can be accessed via:
www.modernisation-initiative.net
or www.gsttcharity.org.uk
The Kidney Disease Modernisation Initiative (KDMI) project included Guy’s and St Thomas’ NHS Foundation Trust, Lambeth Primary Care Trust, Southwark Primary Care Trust, King's College Hospital NHS Foundation Trust and NHS London. The project focused on addressing the CKD patient pathway from diagnosis through to treatment. Work included awareness raising regarding regular blood pressure (BP) checks; and piloting approaches to help GPs identify patients with high blood pressure and better manage their symptoms.
No Delays Achiever - Service Improvement Tools NHS Institute for Innovation and ImprovementAccessed via:www.nodelaysachiever.nhs.uk
This site provides a collection of service improvement tools and techniques tailored to focus on helping to deliver an 18 week pathway for patients.
Chronic Kidney Disease Electronic Advisory Service: SystmOne (2008) TTP website.
Accessed via:www.tpp-uk.com
Clinicians in Bradford are piloting a new scheme aimed at cutting referrals to secondary care and improving the care pathway for Chronic Kidney Disease patients. The Chronic Kidney Disease Electronic Advisory Service (CKDEAS) uses a clinical computer system, SystmOne, as a communication and 'e-consultation' tool between primary and secondary care clinicians.
UK National Screening Committee.
UK National Screening Programme: CKD (2008)
Accessed via:
http://www.screening.nhs.uk
This website of the UK National Screening Committee (UK NSC), is funded by the Health Departments in each of the UK countries. The UK NSC is responsible for providing advice on screening to each of the four countries.
Using research evidence, pilot programs and economic evaluation, it assesses the evidence for programs against a set of internationally recognised criteria covering the conditions, test, treatment options and the effectiveness and acceptability of the screening programs.
The UK NSC regularly reviews policy on screening for different conditions in the light of new research evidence becoming available.
The current position is that there is insufficient evidence to support a population based screening programme for chronic kidney disease.
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Resource Relevance
Useful websites
Better Kidney Care for All
Available from
www.kidneycare.nhs.uk
The website for NHS Kidney Care, which works with clinical teams and commissioners of kidney care to transform the services available to those with kidney disease, in order to continually drive up the quality of care.
Kidney Care MattersCan be accessed via:www.kidneycare.nhs.uk
Kidney Care Matters Online is an e-communications tool from NHS Kidney Care that aims to keep you informed and aware of what is happening across England to ensure successful consistent implementation of the Renal NSF.
The Renal Association – clinical practice guidelines committee
Available from: www.renal.org
This clinical practice guidelines committee prepares guidelines for the renal community in the UK. The committee covers five modules (chronic kidney disease, complications, haemodialysis, peritoneal dialysis, assessment for transplantation, acute renal failure and acute kidney injury).
British Renal Society CKD forum
Available from:
www.britishrenal.org
The CKD forum is a multidisciplinary group of healthcare professionals. It is a project group of the British Renal Society.
NHS Evidence - kidney diseases and male urogenital disorders Available from:
www.library.nhs.uk/kidney/
This NHS specialist library provides high quality information as well as updates regarding latest research and developments in the area of kidney diseases affecting both adults and children.
EdREN - website of the Renal Unit, Royal Infirmary of Edinburgh
A source of useful kidney disease related information including kidney disease referral and management guidelines, a handbook for hospital doctors and staff and EdRenINFO: information about kidney diseases for patients and non-specialist doctors. It should be noted that Scotland has guidance independent from England (Scottish Intercollegiate Guideline Network) and that some content of the EdREN advice or resources may not be consistent with recommendations within the NICE CKD guideline. If EdREN is accessed it should be in conjunction with the NICE CKD quick reference guide or NICE guideline.
East Midlands Renal Network: useful resources for professionals
Available from:
www.emrn.org.uk
This website from the East Midlands Renal Network aims to deliver user-friendly advice and information for both patients and practitioners. Relevant CKD resources for professionals include: classification; prevalence; facts about eGFR; setting up a CKD register; and guidelines.
The Renal Association
UK CDK eGuide
Available from: www.renal.org
The CKD eGuide is derived from the NICE, SIGN and Renal Association guidelines. The aim is to provide quick online support for the diagnosis and management of chronic kidney disease in the community and elsewhere.
NHS Evidence
This is a service that provides easy access, including all NHS staff, to a comprehensive evidence base for everyone in health and social care who takes decisions about treatments or the use of resources – including clinicians, public health professionals, commissioners and service managers.
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Lifestyle advice
Resources RelevanceBlood Pressure Association (2008) Selection of patient information leaflets
Available from: bpa.jamkit.com
The Blood Pressure Association has produced this series of downloadable resources that can be given to people diagnosed with CKD and people with identified risk factors, including:
hypertension
diabetes
cardiovascular disease
structural renal tract disease
multisystem diseases with potential kidney involvement
hereditary kidney disease
haematuria or proteinuria.
This resource page includes links to the following leaflets:
‘High blood pressure: are you at risk? 10 prevention steps’
‘Guidelines for measuring blood pressure at home’
‘Our blood pressure – the facts’
‘Changing your lifestyle to lower blood pressure’.
National Kidney Foundation (2006) Nutrition and chronic kidney disease.
Available from: www.kidney.org
This is an American resource with clear and accessible information on diet and nutrition for people with CKD.
It may need to be adapted for use with UK patients.
If healthcare professionals use this resource it should be in conjunction with the patient lifestyle recommendations in the NICE guideline on CKD.
Useful websites
Diabetes UK www.diabetes.org.uk
British Hypertension Society
www.bhsoc.org
Resources from this website include a diet sheet for patients with hypertension.
Kidney Patient Guide
www.kidneypatientguide.org.uk
British Heart Foundation
www.bhf.org.ukThis is a useful signposting website, particularly for clear, concise patient resources on blood pressure management.
NHS Health Check http://www.dh.gov.uk/en/Healthcare/Vascular/NHShealthcheck/index.htm
The NHS Health Check programme aims to help prevent heart disease, stroke, diabetes and kidney disease. Everyone between the ages of 40 and 74, who has not already been diagnosed with one of these conditions, will be invited (once every five years) to have a check to assess their risk of heart disease, stroke, kidney disease and diabetes and will be given support and advice to help them reduce or manage that risk. Implementation of the programme will be phased and the full implementation is expected by 2012/13.
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Pharmacotherapy
Document RelevanceMarie Curie Institute (2008) Liverpool Care Pathway (LCP) guidelines for LCP drug prescribing in advanced chronic kidney disease. London: Stationery Office.
Available from: www.dh.gov.uk
This is a useful document that applies only to the treatment of patients with advanced CKD, and not those with early CKD who need end of life treatment because of other diseases.
British National Formulary: new information on conditions sucha as nutrition and adjustment of drug dosages in renal impairment (September 2009)
BNF 58 (The British National Formulary) contains new information on conditions such as nutrition and adjustment of drug dosages in renal impairment. See appendix 3.
Department of Health (2004) Management of medicines.
Available from:www.dh.gov.uk
This document is to help organisations implement the medicines management aspects of the diabetes, renal and long-term conditions NSFs. It also gives examples of innovative practice that PCTs and NHS trusts may want to implement.
Useful websites
UK Renal Pharmacy Group website
Accessed via:
www.renalpharmacy.org.uk
Website from the UK Renal Pharmacy Group who aim to facilitate education, training and research for pharmacists (and via them, other health care professionals) involved in provision of pharmaceutical care to patients with renal disease.
South West Medicines Information and Training: Drugs in renal failure (and impairment)
Accessed via:
www.swmit.nhs.uk/renal
NHS SW Medicines Information Centre is the national lead centre for information and advice on the adjustment of drug dosage in patients with renal impairment and/or on renal replacement therapies.
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International resources
Organisation RelevanceWebsite
National Kidney Foundation
An American non profit organisation, the National Kidney Foundation aims to prevent kidney and urinary tract diseases through improving the health and well-being of individuals and families affected by kidney disease.
New Zealand Kidney Foundation
A non-profit organisation, Kidney Health New Zealand funds research into the prevention, early detection and cure of kidney disease and provides education and resources to aid the recognition of the symptoms of kidney disease.
Kidney Health Australia A national organisation which raises awareness of CKD within Australia. Work includes awareness and education programmes, for example, Kidney Evaluation for You: a CKD early detection and prevention programme which aims to identify asymptomatic CKD in high risk individuals and refer them to a primary health care provider for appropriate long-term care.
The Kidney Foundation - Canada
A national non-profit organisation, the Kidney Foundation of Canada provides education, support and awareness raising resources regarding kidney related conditions that include CKD.
National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)
An information dissemination service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institute of Health (NIH), which is part of the US Department of Health and Human Services.
The NIDDK provides a response to inquiries about kidney and urological disease, publications about specific kidney and urological disease, referrals to health professionals, and a database of health education materials.
Note that these resources do not use the NICE stages of CKD.
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Related NICE guidance
Document Relevance
Kidney related Guidance
Anaemia management in people with chronic kidney disease. NICE clinical guideline 39. Available from: www.nice.org.uk/CG39
This guideline provides recommendations on the detection and diagnosis of anaemia in people with chronic kidney disease. The guideline highlights the need for clinicians to consider anaemia and its management when providing care for people with CKD.
Technology appraisals
Home compared with hospital haemodialysis for patients with end-stage renal failure.
NICE Technology Appraisal 48.Available from:www.nice.org.uk/TA48
This Technology Appraisal (TA) provides guidance on the locations in which haemodialysis can be carried out; it includes an examination of the clinical need underpinning this intervention, as well as recommendations on clinical practice for the provision of haemodialysis either at home or within a satellite setting.
Renal transplantation – immuno-suppressive regimens (adults) (review). NICE Technology Appraisal 85. Available from: www.nice.org.uk/TA85
This TA provides guidance on the clinical and cost effectiveness of immuno-suppressive therapy for renal transplantation in adults, and includes recommendations on the following drugs: basiliximab; daclizumab; calcineurin inhibitors, for example such as ciclosporin or tacrolimus; mycophenolate mofetil; and sirolimus.
Renal transplantation – immunosuppressive regimens for children and adolescents. NICE Technology Appraisal 99.
Available from:
www.nice.org.uk/TA99
This TA provides guidance on the use of immunosuppressive drugs in children and adolescents receiving kidney transplants and includes recommendations on the following drugs: basiliximab and daclizumab; tacrolimus; mycophenolate mofetil; mycophenolate sodium; and sirolimus.
Other NICE Guidance
Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence
NICE clinical guideline 76.
Available from:
http://guidance.nice.org.uk/CG76
This guideline offers best practice advice on how to involve patients in decisions about prescribed medicines and how to support adherence. It is thought that between a third and a half of all medicines prescribed for long-term conditions, such as CKD , are not taken as recommended.
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Other NICE Guidance (continued)
Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. NICE clinical guideline 67.
Available from: www.nice.org.uk/CG67
This guideline provides guidance on cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. The target population of the guideline includes adults at higher risk of cardiovascular disease; this population is also at increased risk of chronic kidney disease.
Type 2 diabetes: the management of type 2 diabetes (update). NICE clinical guideline 66.
Available from: www.nice.org.uk/CG66
This guideline focuses on the care and treatment of people with type 2 diabetes. People with diabetes are at an increased risk of developing chronic kidney disease. The guideline includes recommendations on the use of medications to reduce blood pressure, a key risk factor for CKD, as well as advice regarding the detection and ongoing management of allied conditions, including kidney disease.
Hypertension: management of hypertension in adults in primary care. NICE clinical guideline 34. Available from: www.nice.org.uk/CG34
This guideline covers the assessment, monitoring and management of hypertension in primary care. People with hypertension are at an increased risk of developing chronic kidney disease. This guideline includes recommendations regarding lifestyle advice (smoking, diet and exercise) for people with hypertension. Lifestyle changes in smoking, diet or exercise can help to reduce the risk factors for developing CKD within this group.
Diagnosis and management of type 1 diabetes in children, young people and adults
Available from:
http://guidance.nice.org.uk/CG15
The NICE clinical guideline on type 1 diabetes covers the NHS care that should be available to adults with type 1 diabetes. It includes recommendations on how the diagnosis should be made and the options that should be offered at different times.
The guideline also makes recommendations about the diagnosis of type 1 diabetes in children and young people and about the care that should be available for them. It also covers the transition to adult care.
Brief interventions and referral for smoking cessation in primary care and other settings. NICE public health intervention guidance 1.
Available from: www.nice.org.uk/PHI001
This guidance focuses on effective ways to help people stop smoking; it examines the efficacy of smoking cessation brief interventions in encouraging individuals to quit smoking. Smoking increases an individual’s risk of hypertension, which is also a key risk factor for the development of CKD.
Cinacalcet for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy. Jan 2007
This guidance examines the use of Cinacalcet to treat secondary hyperparathyroidism, a consequence of having end-stage renal disease.
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Available from:www.nice.org.uk/TA117
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Feedback
This guide to resources has been designed to provide an overview of
information relevant to the NICE CKD guideline – either in terms of
background such as government policy documents, or practical help such as
pathways or toolkits. The resources listed are available from NICE, national
government and other national organisations.
The guide to resources is due to be reviewed in October 2011. As part of this
process we would welcome your feedback and/or signposting of nationally
applicable, practical tools which are published electronically that could support
healthcare professionals and commissioners in implementing the
recommendations within the CKD guideline.
Please ensure that your suggested resources for inclusion include the
following headings:
Title of resource
Author/s Publication date
URL/location
Applicability/notes
Please send your submissions to [email protected]
by 30 September 2011
Sending us feedback
We would welcome feedback on how useful this tool has been. Please email
your comments to [email protected]
NICE guide to resources: Chronic Kidney Disease 2nd Edition 2010 31 of 32
Acknowledgements
NICE would like to thank
Dr Donal O’Donoghue, National Clinical Director, Department of Health
who contributed to the review of this Guide to Resources.
María J. Vicente Edo, Instituto Aragonés de Ciencias de la Salud,
Zaragoza, Spain who led the review of this second edition of the Guide
to Resources, during a secondment at NICE.
NICE would also like to thank everyone who has contributed to the
development of the original guide to resources:
Dr Donal O’Donoghue, National Clinical Director, Department of Health
Dr David Halpin, Guideline Development Group (GDG) Chair
Dr Paul Stevens, Consultant Nephrologist and Clinical Adviser to the GDG
Ms Natasha McIntyre, Research Fellow in Renal Medicine and GDG
member
Dr Ivan Benett, General Practitioner and GDG member
Dr C Tomson, Consultant Renal Physician representing the British
Hypertension Society
Thank you to the following members of the Pan Birmingham Local Renal
Group who participated in the validation workshop for the first edition of the
guide to resources:
Carol Sidaway
Carol Watson
Mary Bosworth
Paula Mitchell
Smith Steve (Interim Chair)
Carol Willis
Liz Wittich
Nanette Grant (West Midlands Renal Network Manager)
NICE guide to resources: Chronic Kidney Disease 2nd Edition 2010 32 of 32