RCPE Press Release
8 February 2007
NEW UK RECOMMENDATIONS TO IMPROVE DETECTION, CLASSIFICATION AND TREATMENT OF EARLY CHRONIC KIDNEY DISEASE
A new UK-wide consensus statement on early chronic kidney disease has been produced and published at the conclusion of a consensus conference convened by the Royal College of Physicians of Edinburgh (RCPE)1 with the UK and Scottish Renal Associations. The statement includes a number of recommendations aimed at improving the detection, classification, treatment and organisation of care for this condition that is thought to affect about 10% of the population.
Recommendations include -
Improving detection of early CKD: The statement has produced a series of recommendations for laboratories to follow in order to improve the accuracy and reliability of the currently available tests (details available in the full statement). It recognises that the estimated glomerular filtration rate (eGFR) is the most practical indicator of kidney function but has important limitations and that the measurements are subject to analytical and biological variability.
Improving the classification of early CKD: the statement recommends that all patients with suspected early CKD should have a urine dipstick test for proteinuria and, if positive, quantification of the protein:creatinine ratio (PCR). It states that this should be included in the next revision of the Quality and Outcomes Framework for general practice. Patients with significant proteinuria (PCR >100mg/mmol) who are at higher risk of deterioration should be classified with the addition of the suffix "p". The statement also recommends that CKD stage 3 (currently classified as impaired kidney function as defined by an eGFR of between 30-59 ml/min/1.73m2 on at least 2 occasions at a minimum interval of 3 months) should be sub-classified into 2 groups, stage 3A and 3B (3A defines a lower risk group with eGFR of 45-59 and 3B defines a higher risk group with eGFR of 30-44).
Treatment: Blood pressure lowering is the most important measure to treat early CKD and prevent its complications and the statement produces clear guidance on how to do this. There are also recommendations on cardiovascular risk management as this patient group are at higher risk of premature cardiovascular disease.
Improving organisation of care: Although the great majority of patients will be identified and managed in primary care the statement indicates those in whom referral for specialist opinion should be considered -
* younger patients (those under 55),
* those with evidence of progressive kidney disease (fall in eGFR >4mls/min/year) after confirmation with a second blood test
* those with proteinuria (PCR > 100mg/mmol)
The consensus statement will now be disseminated throughout the UK to inform clinical practice and submitted to the Department of Health and Scottish Executive to inform future health policy in this area.
Dr Stuart Rodger, Chairman of the Organising Committee of the Consensus Conference, and a consultant renal physician in Glasgow, said,
"We believe that the consensus statement produced by this event has provided a series of recommendations which will provide much-needed clarity and guidance for all those involved in the detection, classification and treatment of early CKD and consequently will improve patient care.
"Our review has also identified a shortfall in the research evidence base required to underpin robust recommendations in many areas of disease management for patients with early CKD and we hope that the statement will be used not only in clinical practice, but also in determining future areas of research".
Contact: Graeme McAlister on 0131-247-3693 or 07808-939395
Notes to Editors
1. The Consensus Statement was produced during the RCPE Consensus Conference on Early Chronic Kidney Disease, held at the RCPE on 6-7 February 2007.
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