Detecting and managing Chronic Kidney Disease

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1 Detecting and managing Chronic Kidney Disease KCAT Primary Care Nurse Workshop Conceived and developed by the Kidney Check Australia Taskforce sub-committee for education in nursing in general practice 1 V0914

2 KCAT supporters The KCAT program is proudly supported by unrestricted educational grants from: KCAT Program Partners KCAT Major Sponsor 2

3 Learning outcomes At the end of this workshop participants will: Know the eight major risk factors for developing Chronic Kidney Disease (CKD) Understand the recommendations for the detection and staging of CKD Be able to identify the role of the primary care nurse in the detection and management of CKD 3

4 Functions of the kidneys Elimination of metabolic wastes Electrolyte, acid/base and fluid balance Blood pressure regulation Regulation of RBC production Regulation of bone metabolism (vitamin D and calcium) 4

5 What happens to the kidneys in CKD? CKD is a slow but progressive disease in which the nephrons lose their filtering capacity. This leads to a loss of kidney function. The three top causes of kidney failure in Australia are: Diabetes (35% of new cases) Nephritis or inflammation of the kidney (22%) Hypertensive vascular disease (14%) 5

6 What is CKD? Chronic kidney disease is defined as: Glomerular Filtration Rate (GFR) < 60 ml/min/1.73m 2 for 3 months with or without evidence of kidney damage. OR Evidence of kidney damage (with or without decreased GFR) for 3 months: albuminuria haematuria after exclusion of urological causes pathological abnormalities anatomical abnormalities. 6 Chronic Kidney Disease (CKD) Management in General Practice, 2 nd edition. Kidney Health Australia: Melbourne, 2012

7 CKD is a major public health problem 1 in 10 Australian adults has CKD Less than 10% of people with CKD are aware they have the condition You can lose up to 90% of your kidney function before experiencing any symptoms Major independent risk factor for cardiovascular disease Common, harmful & treatable 7 Australian Health Survey, 2013 Chronic Kidney Disease (CKD) Management in General Practice, 2 nd edition. Kidney Health Australia: Melbourne, 2012

8 Kidney disease in Australia Australians aged 18 years 21,000 Dialysis or transplant Less than 10% of these people are aware they have CKD 54, ,000 Stage 4-5 CKD Stage 3 CKD 1,146,000 Stage 1-2 CKD 5+ MILLION AT RISK Hypertension / Diabetes 8 Australian Health Survey 2013; ABS population estimates June 2013; ANZDATA 2012 Report CKD staging is according to the CKD-EPI equation

9 Risk factors for kidney disease Eight major risk factors for CKD Diabetes High blood pressure Smoking Obesity, BMI >30kg/m 2 Age over 60 years Aboriginal or Torres Strait Islander origin Family history of kidney failure Established cardiovascular disease 1 in 3 Australian adults is at increased risk of CKD due to the above risk factors 9 RACGP Guidelines for preventive activities in general practice 8 th edition; Chronic Kidney Disease (CKD) Management in General Practice, 2 nd edition. Kidney Health Australia: Melbourne, 2012

10 Serum creatinine Comparing creatinine and egfr CKD 1&2 GFR has been reduced by 50% but creatinine is still normal CKD 3 CKD 4 CKD GFR ml/min Albuminuria Normal Serum Creatinine Level Actual Serum Creatinine Level Dialysis

11 Staging CKD Combine egfr stage, albuminuria stage and underlying diagnosis to specify CKD stage Albuminuria Stage GFR Stage GFR (ml/min/1.73m 2 ) Normal (urine ACR mg/mmol) Male: < 2.5 Female: < 3.5 Not CKD unless haematuria, structural or pathological abnormalities present Microalbuminuria (urine ACR mg/mmol) Male: Female: Macroalbuminuria (urine ACR mg/mmol) Male: > 25 Female: > 35 3a b <15 or on dialysis Colour-coded Clinical Action Plans 11 Chronic Kidney Disease (CKD) Management in General Practice, 2 nd edition. Kidney Health Australia: Melbourne, 2012

12 Staging CKD To stage CKD combine: 1. Kidney Function Stage (egfr) (stage 1-5) 2. Kidney Damage (Albuminuria) 3. Clinical Diagnosis (underlying cause of CKD) 12

13 The significance of CKD staging using egfr Slows progression Staging CKD using egfr will assist with goals of management of CKD Reduce morbidity & mortality Early Detection & Management Prevent complications Reduce cardiovascular risk Early detection and treatment may reduce the rate of progression of kidney failure and cardiovascular risk by 20 50% 13

14 Kidney Health Check Kidney Health Check Blood Test Urine Test BP Check egfr calculated from serum creatinine Albumin / Creatinine Ratio (ACR) check for albuminuria Blood pressure maintain consistently below BP goal CKD screening should be undertaken as a part of every chronic disease & cardiovascular risk assessment 14 Chronic Kidney Disease (CKD) Management in General Practice, 2 nd edition. Kidney Health Australia: Melbourne, 2012

15 Screening for CKD Risk Factor Recommended Tests Frequency Smoker Diabetes Hypertension Obesity Established cardiovascular disease Family history of kidney failure Aboriginal or Torres Strait Islander origin aged over 30 years Urine ACR egfr Blood Pressure Every 1-2 years* *annually for people with diabetes or hypertension Age over 60 This risk factor alone does not require regular testing If an individual has multiple risk factors, follow a more frequent regime 15 RACGP Guidelines for preventive activities in general practice 8 th edition; Chronic Kidney Disease (CKD) Management in General Practice, 2 nd edition. Kidney Health Australia: Melbourne, 2012

16 Screening Parameter Bloods Urinanalysis Avoid Nephrotoxics Blood Pressure Diabetes Treatment U&E, FBE, lipids, Dipstick, ACR, ACEs or ARBs NSAIDs, Gentamycin 130/70, introduce ACEs or ARBs, lifestyle modification Good glycaemic control, HBA1c <7, medication, lifestyle modification Lifestyle modification Stop smoking, reduce alcohol, increase exercise, dietary advise Education Referral Self management egfr<30ml/min/1.73m², persistent and significant albuminuria Established renal anaemia requiring epo. 16

17 Summary CKD is common, harmful and treatable Early detection is beneficial Systematically identify patients at high risk of CKD (the 8 risk factors) Potential to halve the number of patients Perform a Kidney presenting Health Check with (urine kidney ACR, egfr, failure blood pressure) on at risk patients Maintain blood pressure consistently below the relevant threshold Refer to the CKD staging table and clinical action plans in CKD Management in General Practice Most CKD patients can be managed in general practice GPs and practice nurses play a vital role in detecting and managing CKD 17

18 Resources CKD management in general practice 2012 Guidelines booklet Available at 18

19 Resources CKD management guidelines for general practice Available at 19

20 Resources CKD Patient fact sheets Available along with more kidney health fact sheets at > For Patients > Health Fact Sheets 20

21 Resources Kidney Health Information Service Free call information service for people living with / affected by kidney disease 21

22 Join the Kidney Community KIDNEY COMMUNITY members receive a monthly newsletter from KHA allowing you to access: Information and invitations to KHA's education and support activities Updates on medical research in kidney disease Updates on clinical trials and research opportunities Information on advocacy opportunities and government relations issues Information on community and corporate events held by Kidney Health Australia To join the kidney community, 22

23 23

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