National service framework for Renal Services – Part one and two

Serum creatinine 120 GFR 150 mls/minute Serum creatinine 120 GFR 30 mls/minute

ESTIMATING GFR eGFR (mL/min/1.73m2)= Cockcroft-Gault equation (140-age) x weight x 1.23 x (0.85 if female) Creat [umol/l] MDRD Formula       186 x [Creat(umol/L) x 0.0113]-1.154 x Age-0.203 (x 0.742 if female)

Patients Sarge!........... ..Thousands of ‘em!

0.7% 2.3% 4.7% 0.19% 0.04% Population prevalence of CKD stages (NEOERICA study 2005) 0.7% 2.3% 4.7% 0.19% 0.04%

Patients with stages of CKD in a GP practice of 10,000 Stage 5 CKD 6 60 Stage 4 CKD Stage 3 CKD 380 460 Stage 1-2 CKD

Cardiovascular Mortality Rates are Higher among Dialysis Patients 100 10 1 Dialysis: male 0.1 Dialysis: female General population: male Annual mortality (%) is significantly higher in the dialysis population than in control populations. While this difference is most marked in the younger subset of patients, it is still present in the elderly. Levey AS, Beto JA, Coronado BE, et al. Controlling the epidemic of cardiovascular disease in chronic renal disease: What do we know? What do we need to learn? Where do we go from here? Am J Kidney Dis 1998; 32: 853-906. USRDS 1994-1996 (special data request, HCFA form 2746 no. 23, 26-29, and 31). 0.01 General population: female 0.001 Adapted from Levey AS et al. Am J Kidney Dis 1998; 32: 853-906. DOD/0401-04

CKD stages: Stage GFR (mls/min/1.73m2) Action Required >90 Diagnosis/Treatment Slowing Progression CVD risk reduction 60-89 Estimate Progression 30-59 Evaluate/treat complications 15-29 Preparation for RRT <15 RRT / Conservative management

Medicines management Diet advice Exercise Psychosocial support + DM CKD Stage 1, 2,3 Education Blood pressure Smoking cessation Lipid control Medicines management Diet advice Exercise Psychosocial support + DM + CHD CKD Stage 4 Anaemia Acidosis Bone disease Preparation/choice CKD Stage 5 RRT PD HP Tp

Renal.org Identification, management and referral of adults with chronic kidney disease eGFR calculator