CKD eGFR 45-60

HISTORY Shortcut !CKD

eGFR <60 (or Urine ACR > 3) 2x >3 months apart

No Bg: DM/ HTN, smoking, FHx kidney disease nor autoimmune disorders

No leg swelling, SOB, orthopnoea nor PND.

No anorexia, fatigue, n+v, nor pruritis.

No haematuria nor urinary incontinence or retention.

No arthralgia or rashes.

EXAM Shortcut @CKD

BP , HR .

Abdo SNT no masses, organomegally nor palpable bladder.

Chest clear good ae

No peripheral oedema

Plan Shortcut £CKD

Explained can occur in 30% >70s and eGFR can decline as we get older. Lifestyle measures, weight mx, low salt diet, https://www.healthvermont.gov/sites/default/files/documents/pdf/HPDP-Diabetes_dash%20eating%20plan.pdf

Aware for pneumococcal and yearly influenza vaccine.

Bloods: FBC, Ferritin, Renal function, HbA1c, Lipids. Urine ACR

Renal US if haematuria/ Fam Hx polycystic kidney disease or suspect obstruction.

Offer atorvastatin 20mg as eGFR 60 if eGFR >30 increase dose if <40% fall in non-HDL cholesterol not achieved.

Target BP < 140/90 (<130/80 if ACR>70). ACEi (rampiril)/ ARB first line titrated up over 2 - 4 weeks to maximum tolerated dose.

Advised to avoid NSAIDs. Agree if episode of GE/Dehyd to hold ACEi/ ARB/ metformin/ gliflozin.

For annual renal function test.

Will need referral to nephrology if 5 - year risk of needing renal replacement therapy is >5%. Link to kidney failure risk equation: https://kidneyfailurerisk.com/

If A:C ratio >30 and also has diabetes, a gliflozin (i.e. dapagliflozin) may be used in addition to an ACEi/ ARB (NICE CKD guideline 2021).

Link to evidence for treatment options as per GP Evidence website https://gpevidence.org/conditions/chronic-kidney-disease/