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Identification of progression of CKD

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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:

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