1. National service framework for Renal
Services – Part one and two

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

3. 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 ] x Age (x if female)

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

5. 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%

6. 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

8. 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:
USRDS (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:
DOD/

9. CKD stages:
Stage GFR (mls/min/1.73m2) Action Required
> Diagnosis/Treatment
Slowing Progression
CVD risk reduction
Estimate Progression
Evaluate/treat complications
Preparation for RRT
< RRT / Conservative
management

10. 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

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