<?xml version="1.0" encoding="UTF-8"?>

<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>
  <language value="en"/>
  <text>
    <status value="extensions"/><div xmlns="http://www.w3.org/1999/xhtml">
  <table class="narrative-table">
    <tbody>
<tr>


<th colspan="2" scope="row" class="row-header">Metadata</th>


</tr>



<tr>


<th scope="row" class="row-header">Version</th>



<td class="content-container">2.0.0</td>


</tr>







  
<tr>


<th scope="row" class="row-header">Identifier</th>



<td class="content-container">urn:oid:2.16.840.1.113883.4.642.40.48.34.21</td>


</tr>








<tr>


<th scope="row" class="row-header">Experimental</th>



<td class="content-container">true</td>


</tr>




<tr>


<th scope="row" class="row-header">Use Context</th>



<td class="content-container">
    Clinical Focus

 = 
    Chronic kidney disease (disorder)


</td>


</tr>


<tr>


<th scope="row" class="row-header">Jurisdiction</th>



<td class="content-container">
    World


</td>


</tr>


<tr>


<th scope="row" class="row-header">Topic</th>



<td class="content-container">Treatment
</td>


</tr>







<tr>


<th scope="row" class="row-header">Steward (Publisher)</th>



<td class="content-container">HL7 International / Clinical Decision Support</td>


</tr>



<tr>


<th scope="row" class="row-header">Steward Contact</th>



<td class="content-container">HL7 International / Clinical Decision Support</td>


</tr>







<tr>


<th scope="row" class="row-header">Description</th>



<td class="content-container"><div><p>Chronic Kidney Disease - Ambulatory</p>
</div></td>


</tr>



<tr>


<th scope="row" class="row-header">Copyright</th>



<td class="content-container"><div><p>Copyright © Elsevier, and others.</p>
</div></td>


</tr>




<tr>


<th scope="row" class="row-header">Type</th>



<td class="content-container">
    Order Set


</td>


</tr>




<tr>


<th colspan="2" scope="row" class="row-header">PlanDefinition Action</th>


</tr>

<tr>


<th scope="row" class="row-header">Id</th>



<td class="content-container">cc-cpg-activity-referral-nephrology</td>


</tr>




<tr>


<th scope="row" class="row-header">Title</th>



<td class="content-container">Referrals</td>


</tr>















<tr>


<th scope="row" class="row-header">Grouping Behavior</th>



<td class="content-container">Visual Group</td>


</tr>










  
    
      
      
<tr>


<th colspan="2" scope="row" class="row-header">PlanDefinition Sub-Action (Parent Action ID: cc-cpg-activity-referral-nephrology)</th>


</tr>

<tr>


<th scope="row" class="row-header">Id</th>



<td class="content-container">34387224</td>


</tr>




<tr>


<th scope="row" class="row-header">Title</th>



<td class="content-container">Referral: Nephrology; History: [add diagnosis, symptom(s)]; Question: [add reason for referral]</td>


</tr>


<tr>


<th scope="row" class="row-header">Description</th>



<td class="content-container">Referrals</td>


</tr>
















<tr>


<th scope="row" class="row-header">Required Behavior</th>



<td class="content-container">Could</td>


</tr>


<tr>


<th scope="row" class="row-header">Pre-check Behavior</th>



<td class="content-container">No</td>


</tr>



<tr>


<th scope="row" class="row-header">Definition</th>



<td class="content-container"><a href="ActivityDefinition-cc-cpg-activity-referral-nephrology.html">ReferralNephrology</a></td>


</tr>





    
    
      
<tr>


<th colspan="2" scope="row" class="row-header">PlanDefinition Sub-Action</th>


</tr>

<tr>


<th scope="row" class="row-header">Id</th>



<td class="content-container">34387224</td>


</tr>




<tr>


<th scope="row" class="row-header">Title</th>



<td class="content-container">Referral: Nephrology; History: [add diagnosis, symptom(s)]; Question: [add reason for referral]</td>


</tr>


<tr>


<th scope="row" class="row-header">Description</th>



<td class="content-container">Referrals</td>


</tr>
















<tr>


<th scope="row" class="row-header">Required Behavior</th>



<td class="content-container">Could</td>


</tr>


<tr>


<th scope="row" class="row-header">Pre-check Behavior</th>



<td class="content-container">No</td>


</tr>



<tr>


<th scope="row" class="row-header">Definition</th>



<td class="content-container"><a href="ActivityDefinition-cc-cpg-activity-referral-nephrology.html">ReferralNephrology</a></td>


</tr>





    
  
    
      
      
<tr>


<th colspan="2" scope="row" class="row-header">PlanDefinition Sub-Action (Parent Action ID: cc-cpg-activity-referral-nephrology)</th>


</tr>

<tr>


<th scope="row" class="row-header">Id</th>



<td class="content-container">cc-cpg-activity-referral-dietition</td>


</tr>




<tr>


<th scope="row" class="row-header">Title</th>



<td class="content-container">Referral: Dietitian; History: chronic kidney disease; Question: [add reason for referral]</td>


</tr>


<tr>


<th scope="row" class="row-header">Description</th>



<td class="content-container">Referrals</td>


</tr>
















<tr>


<th scope="row" class="row-header">Required Behavior</th>



<td class="content-container">Could</td>


</tr>


<tr>


<th scope="row" class="row-header">Pre-check Behavior</th>



<td class="content-container">No</td>


</tr>



<tr>


<th scope="row" class="row-header">Definition</th>



<td class="content-container"><a href="ActivityDefinition-cc-cpg-activity-referral-dietitian.html">ReferralDietitian</a></td>


</tr>





    
    
      
<tr>


<th colspan="2" scope="row" class="row-header">PlanDefinition Sub-Action</th>


</tr>

<tr>


<th scope="row" class="row-header">Id</th>



<td class="content-container">cc-cpg-activity-referral-dietition</td>


</tr>




<tr>


<th scope="row" class="row-header">Title</th>



<td class="content-container">Referral: Dietitian; History: chronic kidney disease; Question: [add reason for referral]</td>


</tr>


<tr>


<th scope="row" class="row-header">Description</th>



<td class="content-container">Referrals</td>


</tr>
















<tr>


<th scope="row" class="row-header">Required Behavior</th>



<td class="content-container">Could</td>


</tr>


<tr>


<th scope="row" class="row-header">Pre-check Behavior</th>



<td class="content-container">No</td>


</tr>



<tr>


<th scope="row" class="row-header">Definition</th>



<td class="content-container"><a href="ActivityDefinition-cc-cpg-activity-referral-dietitian.html">ReferralDietitian</a></td>


</tr>





    
  





<tr>
  <th colspan="2" scope="row" class="row-header">Generated using version 0.5.4 of the sample-content-ig Liquid templates</th>
</tr>

    </tbody>
  </table>
</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="2026-04-29T15:06:55+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&#xA;&#xA;&#xA;&#x9;&#xA;&#x9;KEY POINTS&#xA;&#xA;&#x9;&#xA;&#x9;&#x9;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&#xA;&#x9;&#x9;Assessment of both GFR and albuminuria is necessary to diagnose chronic kidney disease and monitor disease progression&#xA;&#x9;&#x9;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&#xA;&#x9;&#x9;Albuminuria is measured by urine albumin/creatinine ratio; greater than 30 mg/g indicates albuminuria&#xA;&#x9;&#x9;Chronic kidney disease is commonly associated with hypertension, diabetes, and cardiovascular disease&#xA;&#x9;&#x9;First line therapy includes ACE inhibitors and/or angiotensin II receptor blockers to reduce albuminuria and hypertension&#xA;&#x9;&#x9;If left untreated, chronic kidney disease can progress to end-stage renal disease requiring dialysis or renal transplant&#xA;&#x9;&#x9;&#xA;&#x9;&#x9;&#x9;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;&#xA;&#x9;&#x9;&#xA;&#x9;&#x9;&#xA;&#x9;&#x9;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&#xA;&#x9;&#xA;&#x9;&#xA;&#xA;&#xA;&#xA;&#x9;&#xA;&#x9;URGENT ACTION&#xA;&#xA;&#x9;&#xA;&#x9;&#x9;Hyperkalemia may require urgent treatment in patients being treated for chronic kidney disease&#xA;&#x9;&#x9;&#xA;&#x9;&#x9;&#x9;Urgent treatment consists of calcium chloride or calcium gluconate and regimens of sodium bicarbonate, glucose and insulin, or nebulized albuterol&#xA;&#x9;&#x9;&#xA;&#x9;&#x9;&#xA;&#x9;&#xA;&#x9;&#xA;&#xA;&#xA;&#xA;&#x9;&#xA;&#x9;PITFALLS&#xA;&#xA;&#x9;&#xA;&#x9;&#x9;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>