Identification of progression of CKD

Progression

• take the following steps to identify progressive CKD
  • obtain a minimum of three GFR estimations over a period of not less than 90 days
  • in people with a new finding of reduced eGFR, repeat the eGFR within 2 weeks to exclude causes of acute deterioration of GFR - for example, acute kidney injury or initiation of ACE inhibitor/ARB therapy
  • define progression as a decline in eGFR of more than 5 ml/min/1.73 m2 within 1 year, or more than 10 ml/min/1.73 m2 within 5 years
  • focus particularly on those in whom a decline of GFR continuing at the observed rate would lead to the need for renal replacement therapy within their lifetime by extrapolating the current rate of decline
• NICE advise primary care clinicians should work with people who have risk factors for progression of CKD to optimise their health. These risk factors are:
  • cardiovascular disease
  • proteinuria
  • hypertension
  • diabetes
  • smoking
  • African, African-Caribbean or Asian family origin
  • chronic use of NSAIDs
  • urinary outflow tract obstruction
• in people with CKD the chronic use of NSAIDs may be associated with progression and acute use is associated with a reversible fall in GFR
  • NICE suggest to exercise caution when treating people with CKD with NSAIDs over prolonged periods of time
    • in patients with NSAIDs, monitor the effects on GFR, particularly in people with a low baseline GFR and/or in the presence of other risks for progression

Reference:

• (1) NICE (September 2008). Chronic Kidney Disease - Early identification and management of chronic kidney disease in adults in primary and secondary care