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 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

: CKD Ambulatory Plan Definition - XML Representation

Active as of 2024-11-21

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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"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: PlanDefinition cc-cpg-plan-ckd</b></p><a name="cc-cpg-plan-ckd"> </a><a name="hccc-cpg-plan-ckd"> </a><a name="cc-cpg-plan-ckd-en-US"> </a><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>url</b>: <a href="PlanDefinition-cc-cpg-plan-ckd.html">PlanDefinition ChronicKidneyDiseaseAmbulatory</a></p><p><b>identifier</b>: <a href="http://terminology.hl7.org/6.1.0/NamingSystem-uri.html" title="As defined by RFC 3986 (http://www.ietf.org/rfc/rfc3986.txt)(with many schemes defined in many RFCs). For OIDs and UUIDs, use the URN form (urn:oid:(note: lowercase) and urn:uuid:). See http://www.ietf.org/rfc/rfc3001.txt and http://www.ietf.org/rfc/rfc4122.txt 

This oid is used as an identifier II.root to indicate the the extension is an absolute URI (technically, an IRI). Typically, this is used for OIDs and GUIDs. Note that when this OID is used with OIDs and GUIDs, the II.extension should start with urn:oid or urn:uuid: 

Note that this OID is created to aid with interconversion between CDA and FHIR - FHIR uses urn:ietf:rfc:3986 as equivalent to this OID. URIs as identifiers appear more commonly in FHIR.

This OID may also be used in CD.codeSystem.">Uniform Resource Identifier (URI)</a>/urn:oid:2.16.840.1.113883.4.642.40.48.34.21</p><p><b>version</b>: 2.0.0</p><p><b>name</b>: ChronicKidneyDiseaseAmbulatory</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/plan-definition-type order-set}">Order Set</span></p><p><b>status</b>: Active</p><p><b>experimental</b>: true</p><p><b>date</b>: 2024-11-21 04:10:48+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>: </p><div><p>Chronic Kidney Disease - Ambulatory</p>
</div><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><a href="http://terminology.hl7.org/6.1.0/CodeSystem-usage-context-type.html#usage-context-type-focus">UsageContextType focus</a>: Clinical Focus</td><td><span title="Codes:{http://snomed.info/sct 709044004}">Chronic kidney disease (disorder)</span></td></tr></table><p><b>jurisdiction</b>: <span title="Codes:{http://unstats.un.org/unsd/methods/m49/m49.htm 001}">World</span></p><p><b>copyright</b>: </p><div><p>Copyright © Elsevier, and others.</p>
</div><p><b>topic</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/definition-topic treatment}">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>: </p><div><p>Chronic Kidney Disease Clinical Overview. ClinicalKey. Source</p>
</div><p><b>url</b>: <a href="http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75E10232E05352E3610A5325">http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75E10232E05352E3610A5325</a></p><h3>Documents</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Url</b></td></tr><tr><td style="display: none">*</td><td><a href="http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75E10232E05352E3610A5325">http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75E10232E05352E3610A5325</a></td></tr></table></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">ReferralNephrology</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">ReferralDietitian</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"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/cqf-knowledgeCapability">
    <valueCode value="publishable"/>
  </extension>
  <url value="http://hl7.org/fhir/uv/cpg/PlanDefinition/cc-cpg-plan-ckd"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.40.48.34.21"/>
  </identifier>
  <version value="2.0.0"/>
  <name value="ChronicKidneyDiseaseAmbulatory"/>
  <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="2024-11-21T04:10:48+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>