1 / 13

Management of eGFR in Primary Care: Nurse Practitioner's Role

This article focuses on the effects of age on eGFR (estimated glomerular filtration rate) and provides guidance on the management of patients with abnormal eGFR in primary care. It also highlights the importance of monitoring proteinuria and provides recommendations for lifestyle modifications and medication management in patients with chronic kidney disease (CKD).

oshea
Download Presentation

Management of eGFR in Primary Care: Nurse Practitioner's Role

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Section 6: Management in primary care Particular emphasis on nurse practitioner’s role

  2. Effects of age on eGFR • The “normal” eGFR is age-related • In normal “healthy” individuals, the eGFR will fall by one percent for every year after 40 years of age • An 80 year old man will have an expected eGFR of 50-60 ml/min • Not all patients with reduced eGFR need active management

  3. % subjects with CKD stage 3 by age and gender East Kent Data 70 50 % 30 10 <45 45-54 55-64 65-74 75-84 >85 Age bands de Lusignan et al 2005

  4. CKD Stage 1 CKD 2 CKD 3 CKD 4 CKD 5 “Normal” inulin GFR declines with age EDTA F 150 100 50 0 70 80 20 30 40 50 60 90

  5. Which individuals with abnormal eGFR should we to worry about? • Those with very poor function for age • Those with deteriorating function • Those who may have reversible/treatable cause (unexplained proteinuria/haematuria) • Those with functional consequences of CKD (anaemia, renal bone disease, persistent hyperkalaemia)

  6. 2008 NICE guidance for CKD – focus on vascular risk • Lifestyle modification • Attention to known CV risk factors • smoking • statins for secondary prevention regardless of lipid level • Anti-platelet drugs for secondary prevention • Medicines management • BP targets

  7. NICE 2008: recommendations for BP control in CKD

  8. NICE 2008: Diagnosis of CKD • Proteinuria=ACR>30 or PCR>50 (NOT dipstick) • 3 eGFR estimations <60 over a period not less than 90 days • Progressive decline defined as eGFR falling by >5mls/min/year • Focus on those whose observed rate of decline would necessitate RRT ‘within their lifetime’

  9. NICE: 2008 Classification of CKDwaking up to the impact of proteinuria • Stage 1: GFR>90 + abnormal urinalysis • Stage 2: GFR 60-89 + abnormal urinalysis • Stage 3A: GFR 45-59 • Stage 3B: GFR 30-44 • Stage 4: GFR 15-29 • Stage 5: GFR <15 or dialysis dependent Suffix P denotes presence of proteinuria (ACR>30 or PCR>50)

  10. QOF indicators for CKD 2009

  11. Monitoring of CKD • Each assessment should include • Review of symptoms and fluid status • Blood pressure • Medication review (metformin, NSAIDs) • Urine ACR or PCR • Blood test for renal and bone status • FBC in advanced CKD

  12. Frequency of monitoring

  13. What data is required for effective referral? • Current creatinine and eGFR • Previous creatinines (tracing back to last normal) • Blood pressures (recent and historical) • Urine dip for blood, ACR/PCR • FBC, Ca, Pi • Renal US only if :- • stage 4 • resistant HT • lower tract symptoms

More Related