Chronic Kidney Disease

Jacqueline Annand CKD Nurse

Mary Simpson CKD Nurse
Joyce Mackie Pre
Dialysis/Transplant liaison Sister

What is CKD?
Chronic Kidney Disease (CKD), is a
progressive loss of renal function over a
period of months or years.
Chronic Renal Failure/Established Renal
Failure (CRF/ERF) is complete, or almost
complete failure of the kidneys to function.

Stages of CKD
Stagea

GFR
(ml/min/1.73 m2)

Description

90

Normal or increased GFR, with other evidence of

kidney damage

6089

Slight decrease in GFR, with other evidence of

kidney damage

3A

4559

3B

3044

Moderate decrease in GFR, with or without other

evidence of kidney damage

1529

Severe decrease in GFR, with or without other

evidence of kidney damage

< 15

Established renal failure

Use the suffix (p) to denote the presence of proteinuria when staging CKD
(recommendation 1.2.1).
a

Causes of CKD

Hypertension
Diabetic nephropathy
Glomerulonephritis
Hereditary disease APKD
Analgesic nsaid
Mechanical obstruction ie prostate
Ageing process

Scope and Range

The Renal Service provides 24hr specialist Renal

care to patients from Grampian, Orkney & Shetland.

It caters for those suffering from Acute Renal Failure

(ARF) and Chronic Renal Failure (CRF), together with
other nephrological problems, during investigation,
diagnosis, treatment of their condition and offers
specialist palliative care.

The main Dialysis Unit and Renal Medical Ward are

situated within Aberdeen Royal Infirmary and there
are Satellite Dialysis Units at Elgin, Peterhead,
Portsoy & Inverurie. There are also satellite
facilities on Orkney & Shetland

Pre-Dialysis & Transplant Clinics are held at

within the main Dialysis Unit & Satellite Units and
other Renal / Nephrology clinics are held at
Woolmanhill

The Renal Transplant Service is provided by NHS

Lothian. Joint Pretransplant assessment clinics
are held at Aberdeen Royal Infirmary,
approximately every 6 weeks in conjunction with
colleagues from NHS Lothian.

Conservative treatment and support is offered to

patients, families and carers of those who decide
not to undergo Renal Replacement Therapy (RRT).

Local Demographics

ARI
Elgin
Peterhead
Inverurie
Banff
Orkney
Shetland
Home
Total

208

PD
Pre-RRT
Transplant

36
106
222

CKD Facts & Figures

1 in 10 people in the UK have CKD. Patients

with CKD are more likely to die than go on
to have dialysis.
Early recognition of CKD permits
intervention to alter the natural history of
the disease nephro-protection,
cardiovascular protection.
30% of patients with advanced CKD are
referred late to nephrology services from
primary and secondary care.
Referral rate doubled in some areas.

Why Role Came About

2006

National Service Framework

Renal recommended that
eGFR (estimated glomerular
filtration rate) based on serum
Creatinine level, age, sex, and race.

.be the recommended formula used

to detect CKD

Job Purpose

To improve outcomes for patients with CKD,

by improving service and quality
Education of patients re BP/glycaemic
control, medication compliance,
supporting lifestyle changes
To enhance links with primary care in
managing the CKD population in the
community
Primary care visits, educational sessions,
meet the team sessions
To provide education to those in primary care
who are dealing with this patient group
GP practice visits, awarene ss sessions,
contactable resource

Job Purpose

To support medical personnel

Back to back clinics with Nephrologists
To develop clinical expertise
Participate in delivery of research and
evidenced based care
To be proactive in developing the role
Teaching/supervising members of MDT
including medical students, pre/post
registration nurses with regard to the
complexities of CKD patient
management

Our Background
Mary
25 yrs renal variety
of posts from staff
nurse, sister, clinic
nurse to research
nurse

7 yrs urology
research

CKD Nurse

Jacqui
1 year assessment &
rehabilitation
14 years renal (ward,
outpatients
haemodialysis,
research and
anaemia)
7 months
secondment clinical
educator
Here & Now!

Case presentation 1

78 yr old woman
Hypertensive. Treated with amlodipine
BP 160/80
Creatinine 119 (eGFR 42)
Urinalysis: trace of blood

Clinic review

BP 140/80
Creatinine 170 (eGFR 27)
Ramipril stopped
4 weeks later creatinine 127 (eGFR 38)

All patients with CKD should have

urinalysis: if proteinuria is detected it
should be quantified by PCR. I suspect
the patients she refers to "with CKD 4 or
5 who are reviewed at the renal clinic
seem to have urinalysis done" are
patients with no (or minimal) proteinuria
on urinalysis, and hence the consultant
does not quantify it at each clinic visit;
or they are already maintained on
appropriate treatment and the level of
proteinuria is stable; or no other
interventionis possible and the
consultant therefore does not measure
it.

2) Quantifying proteinuria. As we discussed this is not

straightforward. Our Lab gives an upper limit for a
"normal" PCR of 20mg/mmolcr - other hospitals may
use 30 or 50. Therefore "proteinuria" is any level
above an arbitary cut-off. In practice the higher it is
the more significant, and I am happy to consider
>50mg/mmol as "significant".
All patients with CKD & proteinuria should be
considered for an ACE-I (but not appropriate for all).
The key target should be BP reduction.
As always the level of proteinuria must be taken in
clinical context. I wouldwant to seea 30-year-old
with a PCR of 80; but would not want to see a 80year-old diabetic with a stable PCR of 80, without
other relevant renal problems.

Some facts regarding

CKD
GFR is inversely related to hypertension and
cardiovascular risk
Symptoms are unusual until GFR is less than
30mls/min/1.73m2
Complications including renal anaemia and bone disease
are
unusual until GFR is less than 30 mls/min/1.73m2
Early CKD is very common
Advanced CKD is relatively uncommon
The epidemiology and natural history of CKD is still largely
unknown