CKD Early Identification

8/12/2019 CKD Early Identification

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Chronic kidney disease

Early identification and management of chronic

kidney disease in adults in primary and secondary

care

!: > 2008

NICE clinical guideline 73

.../73

&!CE J C C== &!CE

=. A = 5 J > > 2009 = =

A= 2007 &!CE' ' = >=' (2007,

2009). > H HHH.../

L &!CE 2008


2/39

Contents

! ................................................................................................................................ 4

- ................................................................................................................... 6

#J >=> ............................................................................................... 7

1 G ................................................................................................................................ 10

1.1 ! ................................................................................................................................... 10

1.2 C= .................................................................................................................................. 14

1.3 !> ............................................................................................................... 15

1.4 ! = = ...................................................................................................... 16

1.5 .................................................................................................................................... 17

1.6 *= ................................................................................................................................ 18

1.7 $J= ............................................................................................................................... 19

1.8 >J ........................................................................................................................... 19

1.9 >= ....................................................................................................................... 22

2 & ........................................................................................ 25

3 !>=> ....................................................................................................................... 26

4 * >> ................................................................................................... 27

4.1 > J ..................................................................................................... 27

4.2 C= = H C#D ......................................................................................... 27

4.3 ACE /A*B J =H == .................................................................. 28

4.4 D > C#D? .............................................................................................. 28

4.5 = > C#D = .................................................... 29

5 = ............................................................................................... 30

5.1 F== = ................................................................................................................................... 30

5.2 !> =................................................................................................................. 30

6 *= &!CE ........................................................................................................... 31

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 2 39


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7 =............................................................................................................. 32

AI A: G= D=> G ....................................................................... 33

&= C== C C C .......................................................................... 35

AI B: G= *H =.................................................................................. 36

AI C: =>....................................................................................................... 37

A = .................................................................................................................... 38

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 3 39


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Introduction

C J (C#D) >= J / . !

>>, =J I H ( I>=,

= ). , = >=J.

= C#D H , > I H

C#D > > J J . C#D =

= = >== =.

C#D ==J J>>. B =, C#D >=

=J ==. > =J

C#D, => >= =

. H, = J>> = H C#D

, = H C#D .

'&= >H = ' '&= #J F

J > =J ' (F-#D!) = C#D. =

C#D . 3O5 >J J =>= = (GF*)

=, H 1 2 = , =>

>, = >=.

30% = H J = =J

> >J J , >=J >J.

2% = & = => J (=J =)

H = = =.

> = (H =)

= = = ==J . == = J J:

= H = C#D

H >> = H

=

H H== = J / >= J

H J >

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 4 39


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H = = J .

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 5 39


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Person-centred care

= = H J .

> = =' . = H

J = J > >

>, H = =. ! = H

J > , = = = ==H

D> =' > =

CJ A. ! =, = = = ==H > =

G>.

G >> H = = =. ! =

J - H > = ' . >

, > = , = ===J . ! =

= = = H = J=, J =

=, = H E=.

! , >= = J =

> . F>= = = > J .

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 6 39
https://www.gov.uk/government/publications/reference-guide-to-consent-for-examination-or-treatment-second-editionhttp://www.justice.gov.uk/protecting-the-vulnerable/mental-capacity-acthttp://www.justice.gov.uk/protecting-the-vulnerable/mental-capacity-acthttp://www.wales.nhs.uk/consenthttp://www.wales.nhs.uk/consenthttp://www.wales.nhs.uk/consenthttp://www.wales.nhs.uk/consenthttp://www.justice.gov.uk/protecting-the-vulnerable/mental-capacity-acthttp://www.justice.gov.uk/protecting-the-vulnerable/mental-capacity-acthttps://www.gov.uk/government/publications/reference-guide-to-consent-for-examination-or-treatment-second-edition


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Key priorities for implementation

J , =>: (AC*) ,

J : (C*) =H == . F

> , C* =. AC*

>> > = H .

- KJ> (ACE )/ -!!

= (A*B) - = H C#D J AC* 30 >/>>=

> (I>=J = C* 50 >/>>= >, J I

0.5 /24 >)1.

3 C#D = = H J:

GF* 45O59 >=/>/1.73 >2 ( 3A)

GF* 30O44 >=/>/1.73 >2 ( 3B).

Stages of chronic kidney disease (updated)

Stagea GFR (ml/min/

1.73 m2)

Description

1 90 > &>= GF*, H J

>

2 60O89 = GF*, H J >

3A 45O59

3B 30O44

GF*, H H

J >

4 15O29 GF*, H H

J >

5 < 15 E= = =

I () H C#D

(>> 1.2.1).

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 7 39


8/39

= H C#D ==H = >==J =

>:

4 5 C#D (H H )

== (AC* 70 >/>>= >, I>=J =

C* 100 >/>>= >, J I 1 /24 >) =

H =J =J

(AC* 30 >/>>= >, I>=J = C* 50 >/>>=

>, J I 0.5 /24 >) H >

=J = > GF* (GF*) (> 5 >=/>/1.73 >2 1 J,

> 10 >=/>/1.73 >2 H 5 J)

J > =J == =

J ( 'J: >>

J = >J ' &!CE == = 34)

= H, , C#D

= J .

= C#D J J ==H :

J

= (> , =, =

= = = )

= = , = == JJ

>=J> H = J => O I>=, J> =

J>

>=J J 5 C#D J J

> .

==H J C#D.

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 8 39


9/39

>>> GF* > = 90 J.

! = H H GF*, GF* H 2 H

I= GF* O I>=, J ;J ACE /A*B J.

D = GF* > 5 >=/>/1.73 >2 H 1 J,

> 10 >=/>/1.73 >2 H 5 J.

F ==J H> = GF*

H= = = => J H => J

I= =.

! = H C#D > J= = =H 140 >> (

120O139 >>) = = =H 90 >>2.

1 H AC* = = ACE >

= H C#D . = ACE I =J

= J, >, =H

= =. ==H =J ==

G= D=> G (GDG) ==I H== H .

2 GDG = =,

= = C#D. ==

= = J =H = , >

I. EI J = &!CE J = (&!CE ==

= 34) ; => = =

=. GDG = ,

>>, H == I H== > C#D.

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 9 39


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1 Guidance

==H == . == = =

> = .

1.1 Investigation

Measurement of kidney function

1.1.1 > >> >, ==

= = > GF* (GF*)

( >> 1.1.2) >

=3.

1.1.2 !D ( = > >J)-= >= D*D

(> = ) > GF*,

J H = =

>=. !==J J K

> H !D ( I>=, KJ> J). -

J ( I>=, " J), >=J J-

;> >> H-=J (

I>=, J = I= =J > >).

1.1.3 , =J J GF* =

(>==J GF* J 1.21 A-C J4).

1.1.4 ! = GF* 60 >=/>/1.73 >2 > H ,

> > GF* > = GF*.

1.1.5 GF* >=J 60 >=/>/1.73 >2 >,

> > 20%

= .

1.1.6 =J > GF* O I>=,

> >J = = =

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 10 39
http://guidance.nice.org.uk/CG73/Guidance/pdf/Englishhttp://guidance.nice.org.uk/CG73/Guidance/pdf/English


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= O = > (=, 51C-EDA, 125!-

=> I=).

1.1.7 ! H I> >= > O I>=,

J=, > = H >= H O

GF* H . (* >= > H== = >

>= > > GF*.)

1.1.8 A = J > 12 =

GF* >. A =J = >=

J J =J H 12

.

1.1.9 A GF* = = 60 >=/>/1.73 >2 =J

= > J H 2 H. ==H

== =J= =J > (M 5%) H

GF*.

Measurement of eGFR: how often? a

A==J == .

D == =J == H C#D.

EI J = == . J

>J H GF* == > J = H==

.

GF* (>=/>/1.73 >2) J= J

1 2 N 60 + J 12 >=J

3A 3B 30O59 6 >=J

4 15O29 3 >=J

5 = GDG .

Proteinuria

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 11 39


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A=> = > =>= . *

== >=J =>, = , ==J .

AC* J C* =H ==

=J C#D. H, >J == =

=J C* J > == .

1.1.10 D J = J =

==J > => =H I =

AC*.

1.1.11 J , AC* ,

J C* =H == . F > , C* =. AC*

>> > = H .

1.1.12 F = , AC* 30 >/>>= > (

I>=J = C* 50 >/>>= >, J

I 0.5 /24 >) = 70 >/>>= (I>=J

= C* = 100 >/>>=, J I =

1 /24 ) = > J =J >>=. ! = AC* 70 >/>>= >, C* 100 >/>>=

>, >= .

1.1.13 ! = H ===J

H AC* 30 >/>>= > ( I>=J

= C* 50 >/>>= >, J I 0.5 /

24 >).

1.1.14 ! = H >=> (AC* > 2.5 >/

>>= > AC* > 3.5 >/>>= H>) ===J

.

1.1.15 A== = H , = H H GF* = 60

>=/>/1.73 >2, = J =>/ I .

>= = = > =J > >= (

=J ).

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 12 39


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1.1.16 J J =J J =>/ I =

H GF* 60 >=/>/1.73 >2 > C#D

( = >> 1.1.22).

Haematuria

1.1.17 >,

>J.

E= = 1+ >.

D >J > =.

1.1.18 = >

> >, H

> = >.

1.1.19 = >, H H , = >

J >=J .

1.1.20 = > = ==H ==J H >, /=>

( >> ), GF* = > =

> .

Early identification

1.1.21 GF* = H I

= =>. C GF* = ==J = =-> J> -= -=>>J (&A!D)

>.

1.1.22 = C#D J J ==H :

J

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 13 39


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= (> , =, =

= = = )

= = , = == JJ

>=J> H = J => O I>=, J>

= J>

>=J J 5 C#D J J

> .

1.1.23 ! , , J

> = C#D. ! >= J>,

J, J = >

= C#D.

1.2 Classification

1.2.1 I () H C#D.

1.2.2 F = J AC* 30 >/

>>= >, C* 50 >/>>= > (I>=J =

J I 0.5 /24 >).

1.2.3 3 C#D = = H J:

GF* 45O59 >=/>/1.73 >2 ( 3A)

GF* 30O44 >=/>/1.73 >

2

( 3B).

Stages of chronic kidney disease (updated)

Stagea

GFR (ml/min/

1.73 m2)

Description

1 90 > &>= GF*, H J

>

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 14 39


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2 60O89 = GF*, H J >

3A 45O59

3B 30O44

GF*, H H

J >

4 15O29 GF*, H H

J >

5 < 15 E= = =

I () H C#D

(>> 1.2.1).

1.2.4 A J C#D, >> = = ==J J

5.

1.3 Information and education

1.3.1 = H C#D > =

C#D, >= .

1.3.2 = > >>, = = H

C#D => > . ==H .

C#D H =?

= = J H J =?

> == C#D, H

H >= >J =

>/>?

= > = H ?

! H HJ = C#D > =' =J =, = ,

H = , = ==H

==?

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 15 39


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H = H ; C#D H J==

==?

, > = => J ( J = > =J > I -

> =) ( =

= ).

C >> >J H .

1.3.3 = H C#D =J > >>

==H > > ==J

> > >.

1.3.4 = = > >>

= J = H= C#D J

== = =.

1.3.5 = = H H = H C#D =

J== H

O I>=, , == =.

1.4 Indications for renal ultrasound

1.4.1 = = == = H C#D H:

C#D (GF* = > 5 >=/>/1.73 >2 H 1 J,

> 10 >=/>/1.73 >

2

H 5 J)

= = >

J>> J

>=J J =JJ J 20

4 5 C#D

J = = J.

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 16 39


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1.4.2 A = H >=J J J

>= >= = = =

>.

1.5 Progression

1.5.1 ==H J C#D.

>>> GF* > = 90 J.

! = H H GF*, GF* H 2 H

I= GF* O I>=, J ;J ACE /A*B J.

D = GF* > 5 >=/>/1.73 >2 H 1

J, > 10 >=/>/1.73 >2 H 5 J.

F ==J H> = GF*

H= = = => J H => J

I= =.

1.5.2 H = H C#D >

=. :

=

J

>

= A J

&A!D

J =H .

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 17 39


18/39

1.5.3 ! = H C#D &A!D >J H

H = == GF*. EI

H = H C#D H &A!D =

>. GF*, ==J = H =H =

GF* / .

1.6 Referral criteria

1.6.1 = H C#D ==H = >==J

= >:

4 5 C#D (H H )

== (AC* 70 >/>>= >, I>=J =

C* 100 >/>>= >, J I 1 /24 >) =

H =J =J

(AC* 30 >/>>= >, I>=J = C* 50 >/

>>= >, J I 0.5 /24 >) H

>

=J = GF* (> 5 >=/>/1.73 >2 1 J, > 10 >=/

>/1.73 >2 H 5 J)

J > =J == =

J ( 'J: >>

J = >J ' &!CE == = 34)

= H, , C#D

= J .

1.6.2 C >> H = J =, >=

= H >J J H C#D

J =.

1.6.3 = > = ;=J , >J =

==H- = ' G J

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 18 39


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= =. ! , = -= =

.

1.6.4 =' H > H

=.

1.6.5 = H C#D = =H = >==J

== , = >= O

I>=, > J=>, >, =

=.

1.7 Lifestyle advice

1.7.1 E = H C#D I, =J H

>.

1.7.2 = H J

= C#D , =J

= = J

, H = =H H -= >=.

1.7.3 J = H I

, = J > >=

.

1.7.4 J = H C#D >,

, , = = H .

1.8 Pharmacotherapy

Blood pressure control

1.8.1 ! = H C#D > J= = =H 140 >>

( 120O139 >>) = = =H

90 >>

6

.

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 19 39


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1.8.2 ! = H C#D , = = H AC* 70 >/>>=

> (I>=J = C* 100 >/>>= >, J

I 1 /24 >) > J= =

=H 130 >> ( 120O129 >>) = =

=H 80 >>6.

Choice of antihypertensive agents

1.8.3 >=> = O J> >

H ACE > A*B ACE

=.

1.8.4 ACE /A*B = H AC* > 2.5 >/

>>= (>) > 3.5 >/>>= (H>)

J C#D 7.

1.8.5 ACE /A*B - = H C#D J

AC* 30 >/>>= > (I>=J = C* 50 >/>>=

>, J I 0.5 /24 >)7.

1.8.6 ACE /A*B - = H C#D AC* 70 >/

>>= > (I>=J = C* 100 >/>>= >,

J I 1 /24 >)

J = 7.

1.8.7 - = H C#D J AC* =

30 >/>>= (I>=J = C* = 50 >/>>=,

J I = 0.5 /24 ) J

> &!CE J (&!CE ==

= 34) >= C#D.

1.8.8 ACE /A*B > >I>> =

-= 8.

1.8.9 > , > = H ACE

A*B J > :

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 20 39


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>= = ACE /A*B,

> GF* > > =J.

Practicalities of treatment with ACE inhibitors/ARBs

1.8.10 ! = H C#D, > > > >

GF* ACE /A*B J. *

>> H 1 2 H ACE /A*B

J .

1.8.11 ACE /A*B J = >==J >

> > =J >=

(J==J > 5.0 >>=/=).

1.8.12 J=> = ACE /A*B, >,

> H > J=>

= > > .

1.8.13 C H > J=>

ACE /A*B, H > > > > >J .

1.8.14 ACE /A*B J > >

6.0 >>=/= > H > J=>

.

1.8.15 F==H ACE /A*B,

>J GF* > > = = 25% => > = = 30%.

1.8.16 ! == GF* =>

ACE /A*B, = 25% (GF*) 30% (>

) =, = 1O2 H. D

>J ACE /A*B GF* = 25%

=> = 30%.

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 21 39


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1.8.17 ! GF* 25% > =>

30% >:

= =>

= > ( I>=, &A!D)

= , ACE

/A*B J =J = =H ,

= J > .

1.8.18 , ACE /A*B = = J

' = =

H .

Statins and antiplatelet drugs

1.8.19 J >J 9 =

(CD)9,10 = H C#D = > = H

C#D = I = = H H

. ! = F>> = =J

> = H C#D.

1.8.20 = H C#D J CD

= = =.

1.8.21 == = H C#D J

CD. C#D =H =

= H > = = H C#D

>== == .

1.8.22 >> =H

= H C#D H J>> J>.

1.9 Other complications

Bone metabolism and osteoporosis

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 22 39


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1.9.1 >> =>, , J > ()

> D == = H 1, 2, 3A 3B C#D

>>.

1.9.2 > =>, = H

4 5 C#D (GF* = 30 >=/>/1.73 >2). D>

J J > = ==

>. I = .

1.9.3 >

= H 1, 2, 3A 3B C#D.

1.9.4 > D => = H C#D :

=== == = H 1, 2, 3A 3B C#D

1-=-JIJ=== (===) 1,25-JIJ===

(==) = H 4 5 C#D.

1.9.5 > => =

1-=-JIJ=== 1,25-JIJ====>11.

Anaemia

1.9.6 ! =J >, >= == = H 3B,

4 5 C#D J > ( = 11.0 /=, 'A>

>> = H J ' &!CE == =

39). D> J J > = == >.

3 GF* >J = == ( I>=, = =, J,

> , >= H , > >= =)

H== = ( I>=, A C).

4 ! = = = A J.

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 23 39


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5 ! = 70 J, GF* 45O59 >=/>/1.73 >2, = >

H J J >, ==J H C#D-=

>=.

6 GDG = =,

= = C#D. ==

= = J =H = , >

I. EI J = &!CE J = (&!CE ==

= 34) ; => = =

=. GDG = ,

>>, H == I H== > C#D.

7 H AC* = ACE > = H

C#D . = ACE I =J

= J, >, =H =

=. ==H =J ==

GDG == I H== H .

8 >> =

ACE A*B J >= C#D.

9 >=

C#D.

10 >J CD = H C#D = > J

A* J: B C, $J (2003) J = . #J

!= 63: 207O210.

11 D= >> >= C#D J

=. J I > J == = .

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 24 39


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2 Notes on the scope of the guidance

&!CE = = H H = H==

H== . = ==.

= =J / = H C#D (=

). ! = H C#D

= = = . ! = = >> C#D = >

J = , J, = .

! = ( 16 J), = = => J,

= H J ;J ( = =) =J =>=,

> C#D, >> J H>

H C#D >> > = H C#D.

How this guideline was developed

&!CE >> &= C== C C C =

=. C = G= D=> G ( I A), H

H = >>. A G= *H= H => = ( I B).

> > H &!CE == = = &!CE

H. A =, 'H &!CE == = =: H =,

= &' ==.

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 25 39
http://www.nice.org.uk/guidance/index.jsp?action=download&o=34402http://www.nice.org.uk/HowWeWorkhttp://www.nice.org.uk/aboutnice/howwework/developingniceclinicalguidelines/developing_nice_clinical_guidelines.jsp?domedia=1&mid=62F02D9B-19B9-E0B5-D4A26EC9A934FDC7http://www.nice.org.uk/aboutnice/howwework/developingniceclinicalguidelines/developing_nice_clinical_guidelines.jsp?domedia=1&mid=62F02D9B-19B9-E0B5-D4A26EC9A934FDC7http://www.nice.org.uk/HowWeWorkhttp://www.nice.org.uk/guidance/index.jsp?action=download&o=34402


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3 Implementation

= C>> > & >

=>= J D> = ' =',

"=J 2004. !>=> == = > =>=

D2. C C5 J = =

H & = = .

&!CE = = = >=> (= =H).

== H.

= = J > == .

C =:

> = H

>=>

>= > == =.

G , H = == > &!CE,

> = .

A > == .

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 26 39
http://www.nice.org.uk/CG073http://www.nice.org.uk/CG073


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4 Research recommendations

G= D=> G > ==H >> ,

H , > &!CE .

G= D=> G' == >> = ==

= ( 5).

4.1 Measurement of kidney function

! >> J >

> > J , ==J H GF* 60 >=/>/1.73 >2

>.

Why this is important

> GF* > >

>= > >= J . H, =>

> > J H== H. C

> J =J == >, ==, = >

J . H = > O I>=,

J C O ==J > J . *

H > ==J =J = =J

GF*, >= J, ==J = =H == =J= =J.

4.2 Cardiovascular risk in people with CKD

E > >> = CD

= H C#D = CD == = H C#D.


= H C#D = CD J > ==J >

CD-= J = J =. B >>

= == =J . A= > =

CD J ==J =J =, =

I >= = = H C#D =H. *

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 27 39


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=J > >> CD = H C#D

> = J .

4.3 ACE inhibitor/ARB therapy for low levels of proteinuria

=J > H ACE /A*B -

C#D H =H == .


ACE /A*B J = H H >=> ==

== >=> H== =. ! = = ACE /A*B

J = H (AC* 30 >/>>= >, = =

J I 0.5 /24 >) H =. H, J

H H ACE /A*B J = H H =H ==

= =

= =. ! = = ACE /A*B J

= H C#D >J == >= . H==

> == = = : .

4.4 Does age or gender matter in CKD?

F > > > J

== GF* .


C#D =J = H , >= > = H C#D. > ==J

> D*D > GF*, H >

. ==J > >

> = H C#D. = = J ==

GF* .

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 28 39


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4.5 Validation of estimating equations in differing CKD

populations

= GF* C A-

C > = =.


D*D >> =J H=J =,

= H = == H C#D. > >

>J = > GF*.

= > == = H C#D, =

D*D J, = =.

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 29 39


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5 Other versions of this guideline

5.1 Full guideline

== =, 'C J : =J >> =

>J J ', = > =

=. ! = J &= C== C C C,

== > H.

5.2 Information for the public

&!CE > = I= =.

& =J I > = >

H > >=.

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 30 39
http://guidance.nice.org.uk/CG73/Guidance/pdf/Englishhttp://publications.nice.org.uk/IFP73http://publications.nice.org.uk/IFP73http://guidance.nice.org.uk/CG73/Guidance/pdf/English


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6 Related NICE guidance

$ >: = > > = =

>J J = . &!CE == = 67 (2008).

J 2 : >> J 2 (). &!CE == = 66 (2008).

A> >> = H J . &!CE == = 39 (2006).

*= J &!CE == = 114

J: >> J = >J . &!CE == = 34

(= &!CE == = 18) (2006).

B = > >J . &!CE

= = 1 (2006).

J 2 : >> J 2 . &!CE == = 87 (2009).

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 31 39
http://www.nice.org.uk/CG067http://www.nice.org.uk/CG066http://www.nice.org.uk/CG114http://www.nice.org.uk/CG034http://www.nice.org.uk/PH001http://www.nice.org.uk/PH001http://www.nice.org.uk/CG87http://www.nice.org.uk/CG87http://www.nice.org.uk/PH001http://www.nice.org.uk/PH001http://www.nice.org.uk/CG034http://www.nice.org.uk/CG114http://www.nice.org.uk/CG066http://www.nice.org.uk/CG067


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7 Updating the guideline

&!CE == = >>

> H >. H 2 4 J =,

H == = = . ! > H =

>, H >J > > >>.

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 32 39


33/39


34/39

Dr Shelagh O'Riordan

C= G, # CJ =

Professor Paul Roderick

* = =, J >

Dr David Stephens

G= , #

The following individuals were not full members of the Guideline Development Group but were

invited to attend specific meetings.

Dr Claire Beeson

C= G, E # =, J = =

'*

Dr Indranil Dasgupta

C= &=, B>> = =, = 'J 2

' G= D=> G

Dr Patrick Fitzgerald

G= , J = ! B

Dr Neil Iggo

C= &=, *J= I CJ =, J =

$H G=

Dr Kanchana Imrapur

G= , J = D

Dr Marta Lapsley

C== B>, E> = J =, J =

E> $>

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 34 39


35/39

Ms Nicola Thomas

$, B=>H = & HJ, J

= & !J

National Collaborating Centre for Chronic Conditions

Ms Lina Bakhshi

!>

Dr Emily Crowe

= * F==H G= D=>

Mr Robert Grant

= A

Dr Suffiya Omarjee (from August 2007 until March 2008)

= E>

Ms Jaim Sutton (until March 2008)

;

Ms Meiyin Tok (until August 2007)

= E>

Mr David Wonderling

= E>

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 35 39


36/39

Appendix B: The Guideline Review Panel

G= *H = = =>

= =J > &!CE = =>

. ! =, = = >> =J

. = = >> > ==H :

>J , J , =J, = = J.

Dr Robert Walker (Chair)

G= , C>

Dr Mark Hill

= A, & >= #

Dr John Harley

C== G $, & C

Ailsa Donnelly

$J >>

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 36 39


37/39

Appendix C: The algorithms

>> > = &!CE HJ. ==

= = HJ =>.

C J &!CE == = 73

L &!CE 2008. A== . $ > > 2008 37 39
http://pathways.nice.org.uk/pathways/chronic-kidney-diseasehttp://guidance.nice.org.uk/CG73/Guidance/pdf/Englishhttp://guidance.nice.org.uk/CG73/Guidance/pdf/Englishhttp://guidance.nice.org.uk/CG73/Guidance/pdf/Englishhttp://guidance.nice.org.uk/CG73/Guidance/pdf/Englishhttp://pathways.nice.org.uk/pathways/chronic-kidney-disease


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39/39

> =J J. & =

HJ H= H >= H .

Copyright

L &= ! = C== EI== 2008. A== . &!CE J

>= H= J, >J

= -- . & J >>= ,

>>= , ==H H H > &!CE.

Contact NICE

&= ! = C== EI==

$= 1A, CJ H, ==J =K, 1 4B

HHH...

@..

0845 003 7780

C J &!CE == = 73
http://www.nice.org.uk/mailto:[email protected]:[email protected]://www.nice.org.uk/

CKD Early Identification

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