Diabetic Conference 2[1]Renal

8/9/2019 Diabetic Conference 2[1]Renal

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Chronic Kidney DiseaseChronic Kidney Disease Jacqueline Annand – CKD Nurse Jacqueline Annand – CKD Nurse

Mary Simpson – CKD NurseMary Simpson – CKD Nurse

Joyce Mackie – Pre Joyce Mackie – Pre

Dialysis/Transplant liaison SisterDialysis/Transplant liaison Sister


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Chronic Kidney Disease (CKD) , is aprogressive loss of renal function over aperiod of months or years.

Chronic Renal Failure/Esta lished RenalFailure (CRF/ERF) is complete, or almostcomplete failure of the !idneys to function.

"hat is CKD#


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Stages of CKDStages of CKD$tage a %FR

(ml/min/&.' m )Description

& ≥ *+ ormal or increased %FR, -ith other evidence of!idney damage

+ 0* $light decrease in %FR, -ith other evidence of!idney damage

1 23 3* 4oderate decrease in %FR, -ith or -ithout otherevidence of !idney damage5 + 22

2 &3 * $evere decrease in %FR, -ith or -ithout otherevidence of !idney damage

3 6 &3 Esta lished renal failurea 7se the suffi8 (p) to denote the presence of proteinuria -hen staging CKD(recommendation &. .&).


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Causes of CKDCauses of CKD

HypertensionHypertensionDia etic nep!ropat!yDia etic nep!ropat!y"lomerulonep!ritis"lomerulonep!ritisHereditary disease – APKDHereditary disease – APKDAnal#esic – nsaidAnal#esic – nsaidMec!anical o struction – ie prostateMec!anical o struction – ie prostateA#ein# processA#ein# process


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Scope and RangeScope and Range

T!e $enal Ser%ice pro%ides &'!r specialist $enal T!e $enal Ser%ice pro%ides &'!r specialist $enalcare to patients (rom "rampian) *rkney + S!etland,care to patients (rom "rampian) *rkney + S!etland,

-t caters (or t!ose su.erin# (rom Acute $enal ailure-t caters (or t!ose su.erin# (rom Acute $enal ailure0A$ 1 and C!ronic $enal ailure 0C$ 1) to#et!er 2it!0A$ 1 and C!ronic $enal ailure 0C$ 1) to#et!er 2it!ot!er nep!rolo#ical pro lems) durin# in%esti#ation)ot!er nep!rolo#ical pro lems) durin# in%esti#ation)dia#nosis) treatment o( t!eir condition and o.ersdia#nosis) treatment o( t!eir condition and o.ersspecialist palliati%e care,specialist palliati%e care,

T!e main Dialysis 3nit and $enal Medical 4ard are T!e main Dialysis 3nit and $enal Medical 4ard aresituated 2it!in A erdeen $oyal -n5rmary and t!eresituated 2it!in A erdeen $oyal -n5rmary and t!ereare Satellite Dialysis 3nits at 6l#in) Peter!ead)are Satellite Dialysis 3nits at 6l#in) Peter!ead)Portsoy + -n%erurie, T!ere are also satellitePortsoy + -n%erurie, T!ere are also satellite(acilities on *rkney + S!etland(acilities on *rkney + S!etland


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Pre7Dialysis + Transplant Clinics are !eld atPre7Dialysis + Transplant Clinics are !eld at2it!in t!e main Dialysis 3nit + Satellite 3nits and2it!in t!e main Dialysis 3nit + Satellite 3nits andot!er $enal / Nep!rolo#y clinics are !eld atot!er $enal / Nep!rolo#y clinics are !eld at4oolman!ill4oolman!ill

T!e $enal Transplant Ser%ice is pro%ided y NHS T!e $enal Transplant Ser%ice is pro%ided y NHS8ot!ian, Joint Pre–transplant assessment clinics8ot!ian, Joint Pre–transplant assessment clinicsare !eld at A erdeen $oyal -n5rmary)are !eld at A erdeen $oyal -n5rmary)appro9imately e%ery : 2eeks in con;unction 2it!appro9imately e%ery : 2eeks in con;unction 2it!collea#ues (rom NHS 8ot!ian,collea#ues (rom NHS 8ot!ian,

Conser%ati%e treatment and support is o.ered toConser%ati%e treatment and support is o.ered topatients) (amilies and carers o( t!ose 2!o decidepatients) (amilies and carers o( t!ose 2!o decidenot to under#o $enal $eplacement T!erapy 0$$T1,not to under#o $enal $eplacement T!erapy 0$$T1,


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Local DemographicsLocal Demographics

ARIARI ElginElgin PeterheadPeterhead

InverurieInverurie BanffBanffOrkneyOrkney ShetlandShetlandHomeHomeTotal 208Total 208

PDPD 36 36Pre-RR !"6Pre-RR !"6

ran#$lant %%%ran#$lant %%%


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CKD Facts & FiguresCKD Facts & Figures

< in =? o( patients 2it! ad%anced CKD arere(erred late to nep!rolo#y ser%ices (romre(erred late to nep!rolo#y ser%ices (romprimary and secondary care,primary and secondary care,$e(erral rate dou led in some areas,$e(erral rate dou led in some areas,


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Why Role Came AboutWhy Role Came About

2 ! "ational Ser#ice Frame$or% 2 ! "ational Ser#ice Frame$or% Renal recommended that'Renal recommended that'

e(FR )e(FR ) estimatedestimated glomerularglomerular*ltration rate+ based on*ltration rate+ based on serumserum

Creatinine le#el, age, se-, and race.Creatinine le#el, age, se-, and race.

'' .be the recommended formula used.be the recommended formula used

to detect CKDto detect CKD


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/ob 0urpose /ob 0urpose

1o impro#e outcomes for patients $ith CKD,1o impro#e outcomes for patients $ith CKD,by impro#ing ser#ice and ualityby impro#ing ser#ice and uality

3ducation of patients re 405glycaemic3ducation of patients re 405glycaemiccontrol, medication compliance,control, medication compliance,supporting lifestyle changessupporting lifestyle changes

1o enhance lin%s $ith primary care in1o enhance lin%s $ith primary care inmanaging the CKD population in themanaging the CKD population in thecommunitycommunity

0rimary care #isits, educational sessions,0rimary care #isits, educational sessions,

meet the team sessionsmeet the team sessions1o pro#ide education to those in primary care1o pro#ide education to those in primary care$ho are dealing $ith this patient group$ho are dealing $ith this patient group

(0 practice #isits, a$arene(0 practice #isits, a$arene ss sessions,ss sessions,contactable resourcecontactable resource


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/ob 0urpose /ob 0urpose

1o support medical personnel1o support medical personnel4ac% to bac% clinics $ith "ephrologists4ac% to bac% clinics $ith "ephrologists

1o de#elop clinical e-pertise1o de#elop clinical e-pertise0articipate in deli#ery of research and0articipate in deli#ery of research ande#idenced based caree#idenced based care

1o be proacti#e in de#eloping the role1o be proacti#e in de#eloping the role1eaching5super#ising members of 6D11eaching5super#ising members of 6D1including medical students, pre5postincluding medical students, pre5postregistration nurses $ith regard to theregistration nurses $ith regard to thecomple-ities of CKD patientcomple-ities of CKD patientmanagementmanagement


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7ur 4ac%ground7ur 4ac%ground

6ary6ary28 yrs renal #ariety28 yrs renal #arietyof posts from sta9of posts from sta9nurse, sister, clinicnurse, sister, clinicnurse to researchnurse to researchnursenurse

: yrs urology: yrs urologyresearchresearch

CKD "urseCKD "urse

/ac ui /ac ui; year assessment &; year assessment &rehabilitationrehabilitation;< years renal )$ard,;< years renal )$ard,outpatientsoutpatientshaemodialysis,haemodialysis,research andresearch andanaemia+anaemia+

: months: monthssecondment clinicalsecondment clinicaleducatoreducator=ere & "o$>=ere & "o$>


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Case presentation ;Case presentation ;

@ yr old 2oman@ yr old 2omanHypertensi%e, Treated 2it! amlodipineHypertensi%e, Treated 2it! amlodipine

BP


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Clinic re#ie$Clinic re#ie$

BP


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All patients 2it! CKD s!ould !a%e

urinalysis i( proteinuria is detected its!ould e quanti5ed y PC$, - suspectt!e patients s!e re(ers to E2it! CKD ' orF 2!o are re%ie2ed at t!e renal clinicseem to !a%e urinalysis doneE arepatients 2it! no 0or minimal1 proteinuriaon urinalysis) and !ence t!e consultantdoes not quanti(y it at eac! clinic %isitGor t!ey are already maintained on

appropriate treatment and t!e le%el o(proteinuria is sta leG or no ot!erinter%ention is possi le and t!econsultant t!ere(ore does not measureit,


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&1 Iuanti(yin# proteinuria, As 2e discussed t!is is not&1 Iuanti(yin# proteinuria, As 2e discussed t!is is notstrai#!t(or2ard, *ur 8a #i%es an upper limit (or astrai#!t(or2ard, *ur 8a #i%es an upper limit (or aEnormalE PC$ o( &=m#/mmolcr 7 ot!er !ospitals mayEnormalE PC$ o( &=m#/mmolcr 7 ot!er !ospitals mayuse >= or F=, T!ere(ore EproteinuriaE is any le%eluse >= or F=, T!ere(ore EproteinuriaE is any le%ela o%e an ar itary cut7o., -n practice t!e !i#!er it isa o%e an ar itary cut7o., -n practice t!e !i#!er it ist!e more si#ni5cant) and - am !appy to considert!e more si#ni5cant) and - am !appy to consider

F=m#/mmol as Esi#ni5cantE,F=m#/mmol as Esi#ni5cantE,All patients 2it! CKD + proteinuria s!ould eAll patients 2it! CKD + proteinuria s!ould econsidered considered (or an AC67- 0 ut not appropriate (or all1,(or an AC67- 0 ut not appropriate (or all1, T!e key tar#et s!ould e BP reduction, T!e key tar#et s!ould e BP reduction,As al2ays t!e le%el o( proteinuria must e taken inAs al2ays t!e le%el o( proteinuria must e taken inclinical conte9t, - 2ould 2ant to see a >=7year7oldclinical conte9t, - 2ould 2ant to see a >=7year7old2it! a PC$ o( =G ut 2ould not 2ant to see a =72it! a PC$ o( =G ut 2ould not 2ant to see a =7year7old dia etic 2it! a sta le PC$ o( =) 2it!outyear7old dia etic 2it! a sta le PC$ o( =) 2it!out

ot!er rele%ant renal pro lems,ot!er rele%ant renal pro lems,


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%FR is inversely related to hypertension andcardiovascular ris!

$ymptoms are unusual until %FR is less than+mls/min/&.' m

Complications including renal anaemia and one diseaseareunusual until %FR is less than + mls/min/&.' m

Early CKD is very common

1dvanced CKD is relatively uncommon

9he epidemiology and natural history of CKD is still largelyun!no-n

Some facts regardingCKD


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Diabetic Conference 2[1]Renal

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