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Prepared by Jennifer CousinClinical Nurse Educator

Hunter Renal Resource Centre

May 2010

Chronic Kidney Disease

Implementing NSW Health Policy Directive

PD2010_023

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What is PD2010_023Policy Directive from NSW DOH, 15th April 2010

Kidney Health Check: Promoting the Early Detection & Management of Chronic Kidney Disease

- Applies to all health facilities

- Initially it will be implemented in all inpatient areas

- Compliance is compulsory

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Normal Kidney Function

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Background

CKD is responsible for a substantial burden of illness and premature death with:

• 1 in 3 Australians at risk of developing the disease;

• 1 in 7 Australians over the age of 25 years having at least one clinical indicator of existing CKD;

• The disease being the 7th leading cause of death;

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Background

• CKD being a preventable and treatable condition. Once the disease is diagnosed and treatment implemented, the progression to end-stage renal failure can be reduced by up to 50%;

• Proteinuria, which is a clinical marker for CKD, is also indicative of an increased risk of cardiovascular disease.

Early detection of CKD is the key to both the prevention and the slowing of the progression of the disease.

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What is Chronic Kidney Disease

Chronic Kidney Disease(CKD) is defined as the occurrence of kidney damage or decreased kidney function(decreased glomerular filtration rate) for a period of three or more months.

The main causes of CKD

- Diabetes, 34% of new cases

- Nephritis, 22% of new patients

- Hypertension, 14% of new cases

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Stages Of CKDeGFR Description Common Symptoms

90Stage 1 CKD – kidney damage with normal kidney function

NilCKD may be indicated in those with increased risk

60 - 89Stage 2 CKD – kidney damage with mild ↓ kidney function

NilHypertension

30 - 59Stage 3 CKD – moderate ↓ kidney function

As for 1 & 2, nocturia, mild malaise, anorexia,

15 - 29Stage 4 CKD – severe ↓ kidney function

As for 3,nausea, pruritis, restless legs, dyspnoea

<15Stage 5 CKD – end stage kidney disease

As for 4

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Kidney Health Screening

The Kidney Health Screening for inpatients is a three step process and

should be undertaken on all adult ward inpatients who have not been

previously diagnosed with kidney disease

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Step 1 – Identify High Risk PatientsCheck to see if the patient falls into a high risk category -

cardiovascular disease; diabetes; Aboriginal and Torres Strait Islander peoples; tobacco smokers. obesity; hypertension; aged over 50 years; and a family history of kidney disease;

If they don’t fall into these categories then you don’t need to complete step 2 & 3 but document that you have completed step 1

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Step 2 - Kidney Health Check

There are three components to the Kidney Health Check

1.Urinalysis

Pt without diabetes

Test for protein Abnormal >30mg/dL

Pt with diabetes Test for albumin Abnormal >3mg/dL

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Step 2 - Kidney Health Check

2.Blood Pressure Assessment

3.Estimated Glomerular Filtration Rate (eGFR)

Considered to be an accurate measure of kidney function,

may not be for certain individuals (eg obese, elderly, <18)

Abnormal Result >140/90 mmHg

Abnormal Result < 60mL/min/1.73m²

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Step 3 - Follow UpIf any of the results are abnormal it may be suggestive of CKD so a referral needs to be

made…..

A referral letter for the GP will be available from the Salmat site and highlights the need to retest patient for CKD in 3 months

The patient should also be given a pamphlet on CKD which contains information on the screening process and emphasises the importance of follow up (Document that this has been completed in patients notes)

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Implications for Wards

Nursing staff need to drive this screening and follow up process

Compliance is compulsory

Regular auditing for compliance will be performed

Initial and ongoing education will need to be provided

Development of HNE intranet site on CKD, for ease of access to resources

 

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Thankyou