Chronic Kidney Disease (Partial Update): Early Identification and Management of Chronic Kidney Disease in Adults in Primary and Secondary Care

Excerpt

The Renal National Service Framework (NSF), and the subsequent NICE Clinical Practice Guideline for early identification and management of adults with chronic kidney disease (CKD) in primary and secondary care (CG73), served to emphasise the change in focus in renal medicine from treatment of established kidney disease to earlier identification and prevention of kidney disease.

CKD describes abnormal kidney function and/or structure. It is common, frequently unrecognised and often coexists with other conditions (for example, cardiovascular disease and diabetes). Moderate to severe CKD also carries an increased risk of other significant adverse outcomes such acute kidney injury, falls, frailty and mortality. The risk of developing CKD increases with increasing age, and some conditions that coexist with CKD become more severe and increasingly prevalent as kidney dysfunction advances. CKD can progress to end-stage kidney disease (ESKD)in a small but significant percentage of people.

CKD is usually asymptomatic but it is detectable, and tests for detecting CKD are both simple and freely available. There is evidence that treatment can prevent or delay the progression of CKD, reduce or prevent the development of complications and reduce the risk of cardiovascular disease. However, because of a lack of specific symptoms, CKD frequently remains undetected and unrecognised. As a consequence people with CKD are often not diagnosed, or diagnosed late when CKD is at an advanced stage. Late diagnosis is associated with increased morbidity, mortality and healthcare associated costs.