NICE expects clinicians to measure proteinuria in more patients

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

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

Patients with an albumin to creatinine ratio (ACR) of 30 or higher should be considered to have therapeutically significant proteinuria.

The draft guidelines also state that ACE-inhibitors or angiotensin receptor blockers (ARBs) should be given to all patients with CKD who have proteinuria, regardless of whether they have CVD or hypertension.

Patients with diabetes and an ACR greater than 2.5 in men or 3.5 in women should be treated with ACE/ARB whether they have hypertension or not, and whatever CKD stage they are at.

Those without diabetes but an ACR of 30 or above should also be treated with ACE or ARB irrespective of CVD or hypertension.

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

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