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
| Active as of 2024-08-23 |
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"display" : "Consider using thiazides as diuretics in patients with early stages of chronic kidney disease.\n\n\n\tWhen GFR falls below 30-50 mL/minute/1.73 m2, thiazides as less effective.\n\n\n\n\tGive loop diuretics once or twice daily to patients with GFR less than 30 mL/minute/1.73 m2 (chronic kidney disease stages 4-5).\n\n\n\n\tInstruct patients to follow a low-sodium diet in addition to using diuretics to optimize volume status.\n\n\n\n\tLimit the use of potassium-sparing diuretics, such as triamterene and amiloride, in patients with chronic kidney disease because of the risk of hyperkalemia.",
"citation" : "Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int. 2012;2 (Suppl), 337-414. Source",
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"display" : "Electrolyte analysis\n\n\n\tAbnormalities of electrolytes and other solutes suggest disorders of renal tubular reabsorption and secretion\n\n\n\n\tPersistent abnormalities (lasting more than 3 months) in serum phosphate, potassium, parathyroid hormone, or calcium levels indicate decreased renal function associated with chronic kidney disease\n\t\n\t\tPotassium: greater than 5.5 mEq/L indicative of hyperkalemia or less than 4.0 mEq/L indicating hypokalemia\n\t\tParathyroid hormone: results greater than 65 pg/mL are above the reference range\n\t\tCalcium: less than 8.4 mg/dL is below the reference range\n\t\tPhosphorus: less than 4.6 mg/dL is below the reference range\n\t\n\t\n\n\n \n\nProvide management of electrolyte disturbances\n\n\n\tHyperkalemia and hypokalemia\n\t\n\t\tHigh (greater than 5.5 mEq/L) or low (less than 4 mEq/L) potassium levels are associated with increased mortality for patients with chronic kidney disease\n\t\tPatients with chronic kidney disease have a high risk of developing hyperkalemia, which can cause cardiac arrhythmias and sudden death\n\t\t\n\t\t\t8% to 73% of patients with chronic kidney disease develop hyperkalemia compared to 2.6% to 3.2% in the general population\n\t\t\n\t\t\n\t\tPatients with hypokalemia have an 82% increased risk of reaching end-stage renal disease\n\t\n\t\n\n\n\n\tHyperphosphatemia\n\t\n\t\tTarget serum phosphorus is 2.7 to 4.6 mg/dL for categories G3 and G4, and 3.5 to 5.5 mg/dL for category G5\n\t\tReduce phosphorus intake and consult nephrologist for treatment with phosphate binders\n\t\n\t\n\n\n \n\n\n\tGuideline recommends monitoring serum levels of calcium, phosphate, PTH, and alkaline phosphatase activity beginning in CKD G3a (Level of recommendation: 1C). In children, we suggest such monitoring beginning in CKD G2 (Level of recommendation: 2D).\n\tIn patients with CKD G3a–G5D, it is reasonable to base the frequency of monitoring serum calcium, phosphate, and PTH on the presence and magnitude of abnormalities, and the rate of progression of CKD(Level of recommendation: Not Graded).\n\t\n\t\tReasonable monitoring intervals would be:\n\t\t\n\t\t\t In CKD G3a–G3b: for serum calcium and phosphate, every 6–12 months; and for PTH, based on baseline level and CKD progression.\n\t\t\t In CKD G4: for serum calcium and phosphate, every 3–6 months; and for PTH, every 6–12 months.\n\t\t\t In CKD G5, including G5D: for serum calcium and phosphate, every 1–3 months; and for PTH, every 3–6 months.\n\t\t\t In CKD G4–G5D: for alkaline phosphatase activity, every 12 months, or more frequently in the presence of elevated PTH.\n\t\t\n\t\t\n\t\n\t\n\tIn CKD patients receiving treatments for CKD-MBD, or in whom biochemical abnormalities are identified, it is reasonable to increase the frequency of measurements to monitor for trends and treatment efficacy and side effects (Level of recommendation: Not Graded).",
"citation" : "KDIGO Board. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2017;7(1), 1-59. Source\n\nChronic Kidney Disease Clinical Overview. ClinicalKey. Source",
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"display" : "For patients with a positive dipstick test (1+ or greater), perform confirmation of proteinuria by a quantitative measurement (protein-to-creatinine ratio or albumin-to-creatinine ratio) within 3 months.\n\n \n\nWhen screening adults at increased risk for chronic kidney disease, measure albumin in a spot urine sample using either of the following: \n\n\n\tAlbumin-specific dipstick\n\n\n\n\tAlbumin-to-creatinine ratio\n\n\nWhen monitoring proteinuria in adults with chronic kidney disease, measure the protein-to-creatinine ratio in spot urine samples using: \n\n\n\tAlbumin-to-creatinine ratio\n\n\n\n\tTotal protein-to-creatinine, only if albumin-to-creatinine ratio is more than 500-1000 mg/g (57-113 mg/mmol)",
"citation" : "Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Inter. 2013;Suppl 3, 1-150. Source",
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IG © 2023+ HL7 International - Clinical Decision Support WG. Package hl7.fhir.uv.cpg.ckd#1.0.0 based on FHIR 4.0.1. Generated 2024-08-23
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