Summary

Our kidneys remove waste products and excess fluid from our body. If a person has Chronic kidney disease (CKD), their kidneys aren't able to do this as well as they should. Symptoms of CKD are usually only seen at an advanced stage of the condition.

Care pathways

This pathway is designed to assess how well patients with CKD are managing their condition, and to make sure that it doesn’t lead to any other health problems such as diabetes or hypertension.

1️⃣ Book the appointment

1. We are using a combination of platforms / tools / teams to book patients in correctly with minimal manual effort. If @Louis Williams hasn’t already been in touch, check out the page to find our Monthly Summary plans or reach out to him to find out what you should be doing:
• If we’re using Hippo Labs, log into app.hippolabs.co.uk to find patient lists (see for more information)
• If we’re using Hero Health or AccuRX, @Louis Williams will send your team manual excel recall lists

2. Call the patient to book an appointment with an HCA or Nursing Associate (F2F)

Appointments should be booked one after another where possible if both F2F, or as close as possible on the same day. It doesn’t matter in which order the patient see these clinicians in.

3. Advise patient that they will have a blood test on the day and they must produce a fresh urine sample.

2️⃣ Patient arrives for appointment

1. Record that the patient has arrived in the appointment book
2. Allow the patient a moment to relax before asking to capture data on height, weight, blood pressure, smoking status, and alcohol status (if possible) and add to patient’s EMIS record
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How-to guides

3️⃣ Carry out review

1. Open the clinical template ‘Chronic Kidney Disease - CKD (v17.4) (Ardens)’ on EMIS
2. Draw bloods (for eGFR, HbA1c, Cholesterol), collect a urine sample from the patient (for urine ACR, urine dipstick), and check that blood pressure has been measured
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Additional tests are required depending on the results of the patients last CKD review:
• If previous eGFR was <45ml/min/1.73m2, check FBC
• If previous eGFR was <30ml/min/1.73m2, check calcium, phosphate, FBC, Vit D and PTH
3. If urine dipstick shows non-visible or visible haematuria book an appointment with an HCA to test for a UTI (see 🧪UTI Process & Urine Dips for more information)
4. Complete the ‘Review - General’ and ‘Review - Investigations’ pages of the template
5. Provide lifestyle advice and make appropriate referrals
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Referrals
6. Offer influenza and pneumococcal vaccination (if appropriate)

4️⃣Check & triage results

1. Task any abnormal results to a GP for review and calculate QRISK2.

5️⃣Review results

1. Review all test results. For guidance on interpreting results, see the CESEL Chronic Kidney Disease Guide.
2. Stage CKD and add the stage to the patient's EMIS record
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Staging CKD
3. Task reception to book the patient a follow-up appointment with a GP or Pharmacist

6️⃣Medication review

1. Open the clinical template ‘Chronic Kidney Disease - CKD (v17.4) (Ardens)’ on EMIS
2. Check that the patient is on a statin or other lipid-lowering therapy
• If not, initiate medication
• If they are but QRISK2 is out of range, review dosage
3. Discuss treatment plan with patient, based on the CE SEL CKD guidelines (pg. 9-11), and complete the template
4. As blood pressure measurements are off-target according to the Hypertension Guidance for Primary Care in South East London, a follow-up will be needed as this could be an indicator of 📈Hypertension
5. As HbA1c is off-target, a follow-up is needed as this could be an indicator of 🍏Pre-diabetes or 🍎Diabetes