Clinical Practice Guidelines
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Clinical Practice Guidelines, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/cqf-recommendations/ and changes regularly. See the Directory of published versions

: Chronic Kidney Disease - Ambulatory Plan Definition - XML Representation

Active as of 2023-12-19

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<PlanDefinition xmlns="http://hl7.org/fhir">
  <id value="cc-cpg-plan-ckd"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-ordersetdefinition"/>
    <profile
             value="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-computableplandefinition"/>
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  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: PlanDefinition</b><a name="cc-cpg-plan-ckd"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource PlanDefinition &quot;cc-cpg-plan-ckd&quot; </p><p style="margin-bottom: 0px">Profiles: <a href="StructureDefinition-cpg-ordersetdefinition.html">CPG Order Set Definition</a>, <a href="StructureDefinition-cpg-computableplandefinition.html">CPG Computable Plan Definition</a></p></div><p><b>CQF Knowledge capability</b>: shareable</p><p><b>CQF Knowledge capability</b>: computable</p><p><b>CQF Knowledge capability</b>: publishable</p><p><b>CQF knowledge representation level</b>: structured</p><p><b>StructureDefinition Work Group</b>: cds</p><p><b>url</b>: <code>http://hl7.org/fhir/uv/cpg/PlanDefinition/cc-cpg-plan-ckd</code></p><p><b>version</b>: 2.0.0-ballot</p><p><b>name</b>: ChronicKidneyDiseaseAmbulatory</p><p><b>title</b>: Chronic Kidney Disease - Ambulatory Plan Definition</p><p><b>type</b>: Order Set <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-plan-definition-type.html">PlanDefinitionType</a>#order-set)</span></p><p><b>status</b>: active</p><p><b>experimental</b>: true</p><p><b>date</b>: 2023-12-19 06:22:49+0000</p><p><b>publisher</b>: HL7 International / Clinical Decision Support</p><p><b>contact</b>: HL7 International / Clinical Decision Support: <a href="http://www.hl7.org/Special/committees/dss">http://www.hl7.org/Special/committees/dss</a></p><p><b>description</b>: Chronic Kidney Disease - Ambulatory</p><h3>UseContexts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style="display: none">*</td><td>Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')</td><td>Chronic kidney disease (disorder) <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#709044004)</span></td></tr></table><p><b>jurisdiction</b>: World <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (m49.htm#001)</span></p><p><b>copyright</b>: Copyright © Elsevier, and others.</p><p><b>topic</b>: Treatment <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-definition-topic.html">DefinitionTopic</a>#treatment)</span></p><blockquote><p><b>relatedArtifact</b></p><p><b>type</b>: justification</p><p><b>display</b>: SYNOPSIS - Chronic Kidney Disease


	
	KEY POINTS

	
		Decline in function of the kidney characterized by at least 3 months of reduced GFR (less than 60 mL/minute/ 1.73 m&amp;sup2;) or at least 3 months of structural or functional kidney damage
		Assessment of both GFR and albuminuria is necessary to diagnose chronic kidney disease and monitor disease progression
		GFR is most commonly estimated through measuring serum creatinine and the use of GFR estimating equations, either the Modification of Diet in Renal Disease Study equation or the Chronic Kidney Disease Epidemiology Collaboration equation
		Albuminuria is measured by urine albumin/creatinine ratio; greater than 30 mg/g indicates albuminuria
		Chronic kidney disease is commonly associated with hypertension, diabetes, and cardiovascular disease
		First line therapy includes ACE inhibitors and/or angiotensin II receptor blockers to reduce albuminuria and hypertension
		If left untreated, chronic kidney disease can progress to end-stage renal disease requiring dialysis or renal transplant
		
			Symptoms of end-stage renal disease (eg, pruritus, refractory electrolyte imbalances, metabolic acidosis, severe nausea, neurologic impairments) typically occur when GFR is 5 to 10 mL/minute/1.73 m&amp;sup2;
		
		
		Carefully monitor electrolyte levels, hemoglobin, parathyroid hormone levels, and sodium bicarbonate levels to detect complications of chronic kidney disease, including cardiovascular disease, anemia, bone mineral disease, and metabolic acidosis
	
	



	
	URGENT ACTION

	
		Hyperkalemia may require urgent treatment in patients being treated for chronic kidney disease
		
			Urgent treatment consists of calcium chloride or calcium gluconate and regimens of sodium bicarbonate, glucose and insulin, or nebulized albuterol
		
		
	
	



	
	PITFALLS

	
		Early stages are often asymptomatic, causing chronic kidney disease to be untreated, leading to further progression of kidney damage and worse prognosis</p><p><b>citation</b>: Chronic Kidney Disease Clinical Overview. ClinicalKey. Source</p><p><b>url</b>: <a href="http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75E10232E05352E3610A5325">http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75E10232E05352E3610A5325</a></p><blockquote><p><b>document</b></p></blockquote></blockquote><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>cc-cpg-activity-referral-nephrology</blockquote><p><b>title</b>: Referrals</p><p><b>groupingBehavior</b>: visual-group</p><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>34387224</blockquote><p><b>title</b>: Referral: Nephrology; History: [add diagnosis, symptom(s)]; Question: [add reason for referral]</p><p><b>description</b>: Referrals</p><p><b>requiredBehavior</b>: could</p><p><b>precheckBehavior</b>: no</p><p><b>definition</b>: <a href="ActivityDefinition-cc-cpg-activity-referral-nephrology.html">Referral: Nephrology; History: [add diagnosis, symptom(s)]; Question: [add reason for referral]</a></p></blockquote><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>cc-cpg-activity-referral-dietition</blockquote><p><b>title</b>: Referral: Dietitian; History: chronic kidney disease; Question: [add reason for referral]</p><p><b>description</b>: Referrals</p><p><b>requiredBehavior</b>: could</p><p><b>precheckBehavior</b>: no</p><p><b>definition</b>: <a href="ActivityDefinition-cc-cpg-activity-referral-dietitian.html">Referral: Dietitian; History: chronic kidney disease; Question: [add reason for referral]</a></p></blockquote></blockquote></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-knowledgeCapability">
    <valueCode value="shareable"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-knowledgeCapability">
    <valueCode value="computable"/>
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  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-knowledgeCapability">
    <valueCode value="publishable"/>
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  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-knowledgeRepresentationLevel">
    <valueCode value="structured"/>
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  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="cds"/>
  </extension>
  <url value="http://hl7.org/fhir/uv/cpg/PlanDefinition/cc-cpg-plan-ckd"/>
  <version value="2.0.0-ballot"/>
  <name value="ChronicKidneyDiseaseAmbulatory"/>
  <title value="Chronic Kidney Disease - Ambulatory Plan Definition"/>
  <type>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/>
      <code value="order-set"/>
      <display value="Order Set"/>
    </coding>
  </type>
  <status value="active"/>
  <experimental value="true"/>
  <date value="2023-12-19T06:22:49+00:00"/>
  <publisher value="HL7 International / Clinical Decision Support"/>
  <contact>
    <name value="HL7 International / Clinical Decision Support"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/dss"/>
    </telecom>
  </contact>
  <description value="Chronic Kidney Disease - Ambulatory"/>
  <useContext>
    <code>
      <system
              value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
      <code value="focus"/>
      <display value="Clinical Focus"/>
    </code>
    <valueCodeableConcept>
      <coding>
        <system value="http://snomed.info/sct"/>
        <code value="709044004"/>
        <display value="Chronic kidney disease (disorder)"/>
      </coding>
    </valueCodeableConcept>
  </useContext>
  <jurisdiction>
    <coding>
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
      <display value="World"/>
    </coding>
  </jurisdiction>
  <copyright value="Copyright © Elsevier, and others."/>
  <topic>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/definition-topic"/>
      <code value="treatment"/>
      <display value="Treatment"/>
    </coding>
    <text value="Treatment"/>
  </topic>
  <relatedArtifact>
    <type value="justification"/>
    <display
             value="SYNOPSIS - Chronic Kidney Disease


	
	KEY POINTS

	
		Decline in function of the kidney characterized by at least 3 months of reduced GFR (less than 60 mL/minute/ 1.73 m&amp;sup2;) or at least 3 months of structural or functional kidney damage
		Assessment of both GFR and albuminuria is necessary to diagnose chronic kidney disease and monitor disease progression
		GFR is most commonly estimated through measuring serum creatinine and the use of GFR estimating equations, either the Modification of Diet in Renal Disease Study equation or the Chronic Kidney Disease Epidemiology Collaboration equation
		Albuminuria is measured by urine albumin/creatinine ratio; greater than 30 mg/g indicates albuminuria
		Chronic kidney disease is commonly associated with hypertension, diabetes, and cardiovascular disease
		First line therapy includes ACE inhibitors and/or angiotensin II receptor blockers to reduce albuminuria and hypertension
		If left untreated, chronic kidney disease can progress to end-stage renal disease requiring dialysis or renal transplant
		
			Symptoms of end-stage renal disease (eg, pruritus, refractory electrolyte imbalances, metabolic acidosis, severe nausea, neurologic impairments) typically occur when GFR is 5 to 10 mL/minute/1.73 m&amp;sup2;
		
		
		Carefully monitor electrolyte levels, hemoglobin, parathyroid hormone levels, and sodium bicarbonate levels to detect complications of chronic kidney disease, including cardiovascular disease, anemia, bone mineral disease, and metabolic acidosis
	
	



	
	URGENT ACTION

	
		Hyperkalemia may require urgent treatment in patients being treated for chronic kidney disease
		
			Urgent treatment consists of calcium chloride or calcium gluconate and regimens of sodium bicarbonate, glucose and insulin, or nebulized albuterol
		
		
	
	



	
	PITFALLS

	
		Early stages are often asymptomatic, causing chronic kidney disease to be untreated, leading to further progression of kidney damage and worse prognosis"/>
    <citation
              value="Chronic Kidney Disease Clinical Overview. ClinicalKey. Source"/>
    <url
         value="http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75E10232E05352E3610A5325"/>
    <document>
      <url
           value="http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75E10232E05352E3610A5325"/>
    </document>
  </relatedArtifact>
  <action id="cc-cpg-activity-referral-nephrology">
    <title value="Referrals"/>
    <groupingBehavior value="visual-group"/>
    <action id="34387224">
      <title
             value="Referral: Nephrology; History: [add diagnosis, symptom(s)]; Question: [add reason for referral]"/>
      <description value="Referrals"/>
      <requiredBehavior value="could"/>
      <precheckBehavior value="no"/>
      <definitionCanonical
                           value="http://hl7.org/fhir/uv/cpg/ActivityDefinition/cc-cpg-activity-referral-nephrology"/>
    </action>
    <action id="cc-cpg-activity-referral-dietition">
      <title
             value="Referral: Dietitian; History: chronic kidney disease; Question: [add reason for referral]"/>
      <description value="Referrals"/>
      <requiredBehavior value="could"/>
      <precheckBehavior value="no"/>
      <definitionCanonical
                           value="http://hl7.org/fhir/uv/cpg/ActivityDefinition/cc-cpg-activity-referral-dietitian"/>
    </action>
  </action>
</PlanDefinition>