0. Chronic Kidney Disease
Implementing NSW Health
Policy Directive
PD2010_023
Prepared by Jennifer Cousin Clinical Nurse Educator Hunter Renal Resource Centre
May 2010

1. What is PD2010_023 Policy Directive from NSW DOH, 15th April 2010
Kidney Health Check: Promoting the Early Detection & Management of Chronic Kidney Disease
Applies to all health facilities
Initially it will be implemented in all inpatient areas
Compliance is compulsory

2. Normal Kidney Function

3. Background
CKD is responsible for a substantial burden of illness and premature death with:
• 1 in 3 Australians at risk of developing the disease;
• 1 in 7 Australians over the age of 25 years having at least one clinical indicator of existing CKD;
• The disease being the 7th leading cause of death;

4. Background
CKD being a preventable and treatable condition. Once the disease is diagnosed and treatment implemented, the progression to end-stage renal failure can be reduced by up to 50%;
Proteinuria, which is a clinical marker for CKD, is also indicative of an increased risk of cardiovascular disease.
Early detection of CKD is the key to both the prevention and the slowing of the progression of the disease.

5. What is Chronic Kidney Disease
Chronic Kidney Disease(CKD) is defined as the occurrence of kidney damage or decreased kidney function(decreased glomerular filtration rate) for a period of three or more months.
The main causes of CKD
Diabetes, 34% of new cases
Nephritis, 22% of new patients
Hypertension, 14% of new cases

6. Stages Of CKD eGFR Description Common Symptoms 90
Stage 1 CKD – kidney damage with normal kidney function
Nil
CKD may be indicated in those with increased risk
Stage 2 CKD – kidney damage with mild ↓ kidney function
Hypertension
Stage 3 CKD – moderate ↓ kidney function
As for 1 & 2, nocturia, mild malaise, anorexia,
Stage 4 CKD – severe ↓ kidney function
As for 3,nausea, pruritis, restless legs, dyspnoea
<15
Stage 5 CKD – end stage kidney disease
As for 4

7. Kidney Health Screening
The Kidney Health Screening for inpatients is a three step process and should be undertaken on all adult ward inpatients who have not been previously diagnosed with kidney disease

8. Step 1 – Identify High Risk Patients
Check to see if the patient falls into a high risk category -
cardiovascular disease;
diabetes;
Aboriginal and Torres Strait Islander peoples;
tobacco smokers.
obesity;
hypertension;
aged over 50 years; and
a family history of kidney disease;
If they don’t fall into these categories then you don’t need to complete step 2 & 3 but document that you have completed step 1

9. Step 2 - Kidney Health Check
There are three components to the Kidney Health Check
1.Urinalysis
Pt without diabetes
Test for protein
Abnormal >30mg/dL
Pt with diabetes
Test for albumin
Abnormal >3mg/dL 9

10. Step 2 - Kidney Health Check
2.Blood Pressure Assessment
3.Estimated Glomerular Filtration Rate (eGFR)
Considered to be an accurate measure of kidney function,
may not be for certain individuals (eg obese, elderly, <18)
Abnormal Result
>140/90 mmHg
Abnormal Result
< 60mL/min/1.73m²

11. Step 3 - Follow Up
If any of the results are abnormal it may be suggestive of CKD so a referral needs to be made…..
A referral letter for the GP will be available from the Salmat site and highlights the need to retest patient for CKD in 3 months
The patient should also be given a pamphlet on CKD which contains information on the screening process and emphasises the importance of follow up (Document that this has been completed in patients notes)

12. Implications for Wards
Nursing staff need to drive this screening and follow up process
Compliance is compulsory
Regular auditing for compliance will be performed
Initial and ongoing education will need to be provided
Development of HNE intranet site on CKD, for ease of access to resources

13. Thankyou