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Practice Guidelines

Chronic kidney disease: summary of updated NICE guidance

BMJ 2021; 374 doi: (Published 06 September 2021) Cite this as: BMJ 2021;374:n1992

Linked Editorial

NICE takes ethnicity out of estimating kidney function

  1. Yolanda V Martinez, technical analyst1,
  2. Ivan Benett, general practitioner2,
  3. Andrew J P Lewington, consultant renal physician3,
  4. Anthony S Wierzbicki, consultation in metabolic medicine/chemical pathology4
  5. on behalf of the Guideline Committee
    1. 1National Institute for Health and Care Excellence, Manchester M1 4BD, UK
    2. 2NHS, Manchester, UK
    3. 3Renal Department, St James’s University Hospital, Leeds, UK
    4. 4Department of Metabolic Medicine/Chemical Pathology, Guy’s & St Thomas’ Hospitals, London, UK
    1. Correspondence to: Y V Martinez yolanda.martinez{at}

    What you need to know

    • The updated guideline does not recommend adjusting the estimation of glomerular filtration rate (GFR) in people of African-Caribbean or African family background

    • Screen people at risk of chronic kidney disease (CKD) using estimated GFR (eGFR) and albumin to creatinine ratio (ACR)

    • Use the four-variable Kidney Failure Risk Equation instead of eGFR threshold for referral

    • Refer adults with CKD and a five year risk of needing renal replacement therapy of >5% (measured with the Kidney Failure Risk Equation) for specialist assessment

    • Offer a sodium-glucose cotransporter-2 (SGLT2) inhibitor, in addition to an optimised dose of angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), to people with type 2 diabetes, an ACR of ≥30 mg/mmol, and who meet the criteria in the marketing authorisation (including relevant eGFR thresholds)

    Chronic kidney disease (CKD) is common, estimated to affect 13% of adults (≥16 years old) in England.1 People with CKD have a wide range of experiences, from being asymptomatic at early stages to kidney failure with advanced disease (see table 1 for a classification of CKD stages). The prevalence of categories G3 to G5 (more severe disease) is 5% for all adults, rising to 34% in people aged 75 and over. As kidney dysfunction advances, the mortality risk increases, as does risk of cardiovascular disease, and some comorbidities (such as diabetes and hypertension) become more severe. Most adults with CKD are managed primarily in primary care, but they may need more input from secondary care as the disease progresses.

    View this table:
    Table 1

    Classification of chronic kidney disease (CKD) in adults, and risk of adverse outcomes by category

    In August 2021, the National Institute for Health and Care Excellence (NICE) published NG203,2 an updated and combined version of three guidelines: “chronic kidney disease in adults: assessment and management,” “chronic kidney disease (stage 4 or 5): management …

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