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Section 5: Configuration of
healthcare to manage CKD
The Renal NSF: Part 1
• Standard 1: Patient
centred service
• Standard 2:
Preparation and
choice
• Standard 3: Elective
Dialysis access
surgery
• Standard 4: Dialysis
• Standard 5:
Transplantation
The Renal NSF: Part 2
• Quality requirement 1:
Prevention and early
detection of chronic kidney
disease (CKD)
• Quality requirement 2:
Minimising the progression
and consequences of CKD
• Quality requirement 3:
Acute renal failure
• Quality requirement 4:End
of life care
Management of CKD
Early Detection of CKD
Think/Report
eGFR
Delay progression &
reduce CVS Risk
Prevent uraemic
complications
Modify co morbidities
Prepare for RRT
ACE inhibitors
Malnutrition
Cardiac disease
Education
BP control
Anaemia
Vascular disease
Informed choice of
RRT/conservative
management
Glucose control
Calcium Phosphate
PTH
Drug interactions
Timely access
placement/
Transplant Listing
Smoking cessation
Acidosis
Neuropathy/
Retinopathy
Timely initiation of
RRT
CKD = chronic kidney disease; RRT = renal replacement therapy
NEOERICA: percentage recording of creatinine
and prevalence of Stage 3–5 CKD by age
Patients (%)
80
Recorded serum creatinine
Stage 3–5 CKD
70
60
50
40
30
20
10
0
15–24
25–34
35–44
45–54
55–64
Age groups
65–74
75–84
85+
Source of Late Referrals
Lamiere - NDT 1999
70
60
50
40
30
20
10
0
GP
Gen. Med
Urology
Endocrine Cardiology
NEPHROLOGISTS
GEN. PRACTICE
GEN. MEDICINE
DIABETOLOGISTS
CARDIOLOGISTS
SILO MANAGEMENT
GEN. PRACTICE
GEN. MEDICINE
DIABETOLOGISTS
CARDIOLOGISTS
SILO MANAGEMENT
INTEGRATED MANAGEMENT
CHRONIC
DISEASE
MANAGEMENT
CKD: An Overall Health
Approach
Complications
Normal
Increased
risk
Screening
for CKD
risk factors
CKD risk
factor
reduction,
screening
for CKD
Damage
GFR
Kidney
failure
Diagnosis
Estimate
Replacement
and treatment, progression,
by dialysis
treat
treat
and transplant
comorbid
complications,
conditions,
prepare for
slow
replacement
progression
DEATH
Cardiac Kidney Diabetes
Anti coagulation
Anti arrhythmics
Medical treatment of CHF
CKD Stage 4
CKD Stage 1, 2,3
Anaemia
Acidosis
Bone disease
Preparation/choice
+ DM + CHD
Education
Blood pressure
Smoking cessation
Lipid control
Medicines Management
Diet advice
Exercise
Psychosocial support
CKD Stage 5
RRT
PD
HP
Tp
Radiology
Surgical interventions
Glycaemic
control
Complications
eyes
feet
kidney
QOF indicators for CKD 2009
Register of patients over 18 with CKD 3-5
6
Percentage of patients on the CKD register
whose notes have a record of BP reading in
last 15 months
6
40-90%
11
40-70%
Percentage of patients on the register with
hypertension and proteinuria treated with an
ACE-I or ARB (unless side-effects are
recorded)
4
40-80%
Percentage of patients on the register whose
notes have a record of urine ACR or PCR in
the previous 15 months
6
40-80%
Percentage of patients on the CKD register in
whom the last BP reading, measured in the
last 15 months was 140/85 or less