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Practice Guidelines

Early identification and management of chronic kidney disease in adults: summary of updated NICE guidance

BMJ 2014; 349 doi: (Published 24 July 2014) Cite this as: BMJ 2014;349:g4507
  1. Serena Carville, associate director1,
  2. David Wonderling, head of health economics1,
  3. Paul Stevens, consultant nephrologist2
  4. on behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2East Kent Hospitals University NHS Foundation Trust, Canterbury CT1 3NG, UK
  1. Correspondence to: P Stevens pstevens{at}

The publication of an internationally accepted definition and classification of chronic kidney disease (CKD) 12 years ago precipitated a proliferation of research and literature surrounding the identification of CKD, risk factors for progression, and important prognostic factors.1 It also stimulated continuing debate concerning the criteria used for definition of CKD and exactly how ageing influences CKD and its sequelae.2 3 The National Institute for Health and Care Excellence (NICE) has modified its previous recommendations on the classification of CKD,4 partly based on Kidney Disease Improving Global Outcomes (KDIGO)5 and driven by prognostic data from large observational studies. NICE has also recognised a requirement for better identification of people at risk of adverse outcome and covers some key areas relating to the management of CKD, including frequency of monitoring, progression of CKD, acute kidney injury, and renin-angiotensin system blockade. This article summarises the most recent recommendations from NICE.6


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Investigations for chronic kidney disease

  • Clinical laboratories should:

    • -Use the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation to estimate GFRcreatinine, using creatinine assays with calibration traceable to standardised reference material

    • -Use creatinine assays that are specific (for example, enzymatic assays) and zero biased compared with isotope dilution mass spectrometry and

    • -Participate in a UK national external quality assessment scheme for creatinine.

    • (New recommendation.) [Based on high quality observational studies and the experience and opinion of the GDG]

  • Consider using eGFRcystatinC at initial diagnosis to confirm or rule out CKD in people with:

    • -An estimated GFRcreatinine of 45-59 mL/min/1.73 m2 …

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