GPs to test and treat proteinuria in CKD cases

NICE draft guidance on CKD calls for albumin creatinine ratio as well as eGFR to be measured in primary care.

GPs will have to measure and treat proteinuria in more patients with chronic kidney disease (CKD) under draft NICE guidelines issued last week.

These recommend that patients with an estimated glomerular filtration rate (eGFR) of 60ml/min/1.73m2 or under should have urinary albumin and protein quantified by lab tests.

Patients with an albumin to creatinine ratio (ACR) of 30mg/mmol or higher should be considered to have therapeutically significant proteinuria and given ACE-inhibitors or angiotensin receptor blockers (ARBs) regardless of whether they have cardiovascular disease.

The proposed NICE guidance states that where indicated, use of these drugs should not be influenced by patient's age.

'There is no evidence their appropriate use in older people is associated with a greater risk of adverse effects,' it says.

DoH renal czar Dr Donal O'Donogue welcomed the guidelines which he said were 'evidence based'.

He said the focus on identification and treatment of proteinuria would help GPs build on the success of the CKD quality framework targets.

'We can build on the visibility that kidney disease has now because of the quality framework and really start to provide health gains.'

The clear rule about when to use ACE inhibitors and ARBs would be of benefit to GPs, he added.

'The fourth CKD quality indicator states that all patients with CKD should be treated with an ACE inhibitor or ARB, but the real benefit is in those with proteinuria,' said Dr O'Donogue.

'If you have a raised ACR you should be on these drugs no matter what your BP.'

The NICE document will be open for consultation until early May.

NICE CKD draft guideline

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