Early identification and management of chronic kidney disease: summary of NICE guidanceBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1530 (Published 29 September 2008) Cite this as: BMJ 2008;337:a1530
- Emily Crowe, research fellow1,
- David Halpin, consultant physician & honorary senior clinical lecturer2,
- Paul Stevens, consultant nephrologist3
- on behalf of the Guideline Development Group
- 1National Collaborating Centre for Chronic Conditions, Royal College of Physicians, London
- 2Royal Devon & Exeter Hospital, Exeter
- 3Kent and Canterbury Hospital, Canterbury CT1 3NG
- Correspondence to: P Stevens
Why read this summary?
Chronic kidney disease is associated with substantial comorbidity including hypertension, cardiovascular disease, anaemia, and renal bone disease. People with chronic kidney disease have a far greater likelihood of cardiovascular death than progression to established renal failure (requiring dialysis or kidney transplantation).1 2 3 4 Chronic kidney disease has been highlighted as a public health problem through the international adoption of the US National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative staging system and because the prevalence of the disease as defined by the staging system has risen from 10% (in 1988-94) to 13% (in 1999-2004) of the non-institutionalised adult US population.5 6 7 The staging system (which comprises five stages, 1-5) defines chronic kidney disease on the basis of either evidence of kidney damage (proteinuria, haematuria, or anatomical abnormality) or an impaired glomerular filtration rate <60 ml/min/1.73 m2, present on at least two occasions over three months or longer. The use of a threshold of estimated glomerular filtration rate, uncorrected for age or sex, to define disease has been rightly criticised.8 Nevertheless, based on this definition, the age standardised prevalence of stages 3-5 of chronic kidney disease was 8.5% in a representative UK population.9
This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) for identifying and managing chronic kidney disease.
NICE recommendations are based on systematic reviews of the best available evidence. When minimal evidence is available, recommendations are based on the Guideline Development Group’s opinion of what constitutes good practice. Evidence levels for the recommendations are given in italics in square brackets.
Classification of chronic kidney disease
Because of evidence about differences in risk of adverse outcomes (particularly cardiovascular disease) with declining glomerular filtration rate, stage 3 should be split into two subcategories defined by glomerular filtration rate (table 1 …