Clinical Practice Guidelines Example Implementation Guide - Chronic Kidney Disease
1.0.0 - ci-build
Clinical Practice Guidelines Example Implementation Guide - Chronic Kidney Disease
1.0.0 - ci-build
Clinical Practice Guidelines Example Implementation Guide - Chronic Kidney Disease, published by HL7 International - Clinical Decision Support WG. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/cpg-example-ckd/ and changes regularly. See the Directory of published versions
| Official URL: http://hl7.org/fhir/uv/cpg/ckd/PlanDefinition/cc-cpg-plan-ckd | Version: 1.0.0 | |||
| Active as of 2024-03-01 | Computable Name: ChronicKidneyDiseaseAmbulatory | |||
Usage:Clinical Focus: Chronic kidney disease (disorder) |
||||
Copyright/Legal: Copyright © Elsevier, and others. |
||||
Chronic Kidney Disease - Ambulatory
Generated Narrative: PlanDefinition
Resource PlanDefinition "cc-cpg-plan-ckd"
CQF Knowledge capability: shareable
CQF Knowledge capability: computable
CQF Knowledge capability: publishable
CQF knowledge representation level: structured
url: http://hl7.org/fhir/uv/cpg/ckd/PlanDefinition/cc-cpg-plan-ckd
version: 1.0.0
name: ChronicKidneyDiseaseAmbulatory
title: Chronic Kidney Disease - Ambulatory Plan Definition
type: Order Set (PlanDefinitionType#order-set)
status: active
experimental: true
date: 2024-03-01 20:11:40+0000
publisher: HL7 International - Clinical Decision Support WG
contact: HL7 International - Clinical Decision Support WG: http://www.hl7.org/Special/committees/dss/index.cfm
description: Chronic Kidney Disease - Ambulatory
| Code | Value[x] |
| Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus') | Chronic kidney disease (disorder) (SNOMED CT#709044004) |
jurisdiction: World (m49.htm#001)
copyright: Copyright © Elsevier, and others.
topic: Treatment (DefinitionTopic#treatment)
relatedArtifact
type: justification
display: 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 m²) 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 m² 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: Chronic Kidney Disease Clinical Overview. ClinicalKey. Source
document
library: Chronic Kidney Disease (CKD) risk screening logic
action
id
34387235title: Assessment Scales
groupingBehavior: visual-group
action
id
34387238title: GFR Equations and Classification according to GFR Category
description: Nonorderable narrative
textEquivalent: GFR Equations and Classification according to GFR Category
documentation
requiredBehavior: could
precheckBehavior: no
action
id
34387242title: General Care
groupingBehavior: visual-group
action
id
34387243title: Patient Education
documentation
groupingBehavior: visual-group
action
action
action
id
34387251title: Medications
documentation
type: justification
display: Drug therapy Select drug dosages based on GFR, and carefully monitor kidney function when prescribing nephrotoxic medications, as change in renal function alters drug metabolism Consult the Kidney Disease: Improving Global Outcomes Conference report for detailed dosing considerations and strategies for acute and chronic kidney disease Considerations for drugs commonly used by patients with chronic kidney disease ACE inhibitors Used to reduce blood pressure in the kidneys and reduce albuminurin Dual therapy with angiotensin receptor blockers is not recommended Use lower dose in patients with GFR less than 45 mL/minute/1.73 m²; do not routinely discontinue when GFR is less than 30 mL/minute/1.73 m² (remains nephroprotective) Follow serum potassium Angiotensin receptor blockers Used to reduce blood pressure in the kidneys and reduce albuminuria Dual therapy with ACE inhibitor is not recommended Use lower dose in patients with GFR less than 45 mL/minute/1.73 m²; do not routinely discontinue when GFR is less than 30 mL/minute/1.73 m² (remains nephroprotective) Follow serum potassium Calcium channel blockers Can be used in combination with ACE inhibitor or angiotensin receptor blocker to control hypertension 3 main classes Benzothiazepines (diltiazem) Preferred over dihydropyridines because of an antiproteinuric effect Phenylalkylamines (verapamil) Preferred over dihydropyridines because it has an antiproteinuric effect (no clear indication to discriminate use of benzothiazepines versus phenylalkylamines) Dihydropyridines (eg, nifedipine, amlodipine) Avoid prescribing calcium channel blockers without ACE inhibitor or angiotensin II receptor blocker, as sole use can lead to increased hyperfiltration and increased albuminuria Aldosterone receptor antagonists Spironolactone (nonselective) Carefully monitor for hyperkalemia Eplerenone (selective) Carefully monitor for hyperkalemia Antidiabetic agents Choice of therapy depends on type of diabetes, degree of glycemic control needed, and level of current kidney function Insulin May need dose reduction when GFR is less than 30 mL/minute/1.73 m² to avoid hypoglycemia as insulin is partly renally excreted No evidence-based guidelines or recommendations exist specifying which types of insulin to use or avoid depending on severity of chronic kidney disease Sulfonylureas First-generation sulfonylureas are contraindicated as they are affected by kidney function and increase risks of hypoglycemia Glipizide Second-generation sulfonylurea; preferred in patients with chronic kidney disease as it is metabolized primarily in the liver Biguanides Metformin Relatively contraindicated when GFR is less than 30 mL/minute/1.73 m² as there is a risk of lactic acidosis; consider risk-benefit if GFR is stable Diuretics Monitor for hyperkalemia and hypotension as diuretics can cause fluid imbalance resulting in electrolyte level disparities Thiazide Once daily recommended in patients with GFR of 30 mL/minute/1.73 m² or higher (categories G1-G3) Loop diuretics Once or twice daily recommended in patients with GFR less than 30 mL/minute/1.73 m² (categories G4-G5) Analgesics Acetaminophen is the analgesic recommended for short-term treatment of mild to moderate pain in patients with stages 3 to 5 chronic kidney disease; considered analgesic of choice for all patients with chronic kidney disease NSAIDs may be used for short-term therapy in patients up to stage 3 chronic kidney disease, with regular monitoring of renal function
citation: Chronic Kidney Disease Clinical Overview. ClinicalKey. Source
document
groupingBehavior: visual-group
action
id
34387256title: Antihypertensives
documentation
groupingBehavior: visual-group
action
action
action
id
34387261title: Antilipemics
groupingBehavior: visual-group
action
action
id
34387265title: Diuretics
documentation
groupingBehavior: visual-group
action
action
id
34387287title: Laboratory
groupingBehavior: visual-group
action
id
34387288title: Chemistry
documentation
groupingBehavior: visual-group
action
action
id
34387206title: Urine
documentation
groupingBehavior: visual-group
action
action
id
34387217title: Radiology
groupingBehavior: visual-group
action
id
cc-cpg-activity-ultrasound-renaltitle: Ultrasound
groupingBehavior: visual-group
action
action
id
cc-cpg-activity-referral-nephrologytitle: Referrals
groupingBehavior: visual-group
action
id
34387224title: Referral: Nephrology; History: [add diagnosis, symptom(s)]; Question: [add reason for referral]
description: Referrals
requiredBehavior: could
precheckBehavior: no
definition: Referral: Nephrology; History: [add diagnosis, symptom(s)]; Question: [add reason for referral]
action
id
cc-cpg-activity-referral-dietitiontitle: Referral: Dietitian; History: chronic kidney disease; Question: [add reason for referral]
description: Referrals
requiredBehavior: could
precheckBehavior: no
definition: Referral: Dietitian; History: chronic kidney disease; Question: [add reason for referral]
IG © 2023+ HL7 International - Clinical Decision Support WG. Package hl7.fhir.uv.cpg.ckd#1.0.0 based on FHIR 4.0.1. Generated 2024-03-01
Links: Table of Contents |
QA Report
| Version History 
|