Post on 31-Dec-2015
transcript
The Renal NSF: Part 1
• Standard 1: Patient centred service
• Standard 2: Preparation and choice
• Standard 3: Elective Dialysis access surgery
• Standard 4: Dialysis• Standard 5:
Transplantation
The Renal NSF: Part 2
• Quality requirement 1: Prevention and early detection of chronic kidney disease (CKD)
• Quality requirement 2: Minimising the progression and consequences of CKD
• Quality requirement 3: Acute renal failure
• Quality requirement 4:End of life care
Delay progression & reduce CVS Risk
Prevent uraemic complications
Modify co morbidities Prepare for RRT
ACE inhibitors Malnutrition Cardiac disease Education
BP control Anaemia Vascular disease Informed choice of RRT/conservative
management
Glucose control Calcium Phosphate PTH
Drug interactions Timely access placement/
Transplant Listing
Smoking cessation Acidosis Neuropathy/
Retinopathy
Timely initiation of RRT
Management of CKD
CKD = chronic kidney disease; RRT = renal replacement therapy
Early Detection of CKDEarly Detection of CKD Think/Report eGFR
NEOERICA: percentage recording of creatinine
and prevalence of Stage 3–5 CKD by age
0
10
20
30
40
50
60
70
80
15–24 25–34 35–44 45–54 55–64 65–74 75–84 85+
Age groups
Patients (%)
Recorded serum creatinine Stage 3–5 CKD
Source of Late Referrals Lamiere - NDT 1999
0
10
20
30
40
50
60
70
GP Gen. Med Urology Endocrine Cardiology
DIA
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GIS
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CA
RD
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N. P
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CT
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NE
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GIS
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SILO MANAGEMENT
DIA
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CA
RD
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GE
N. M
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N. P
RA
CT
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SILO MANAGEMENT
CHRONIC DISEASE
MANAGEMENT
INTEGRATED MANAGEMENT
GFR
CKD: An Overall Health Approach
Complications
CKD risk factor
reduction, screening for CKD
Diagnosisand treatment,
treatcomorbid conditions,
slow progression
Estimate progression,
treatcomplications,
prepare for replacement
Replacementby dialysis
and transplant
Screeningfor CKD
risk factors
Kidneyfailure
DamageIncreasedrisk
Normal DEATH
CKD Stage 1, 2,3
EducationBlood pressure
Smoking cessationLipid control
Medicines ManagementDiet adviceExercise
Psychosocial support
CKD Stage 4
AnaemiaAcidosis
Bone diseasePreparation/choice
CKD Stage 5
RRTPDHPTp
Glycaemic control
Complicationseyesfeet
kidney
RadiologySurgical interventions
Anti coagulationAnti arrhythmics
Medical treatment of CHF
+ DM + CHD
Cardiac Kidney Diabetes
QOF indicators for CKD 2009Register of patients over 18 with CKD 3-5 6
Percentage of patients on the CKD register whose notes have a record of BP reading in last 15 months
6 40-90%
Percentage of patients on the CKD register in whom the last BP reading, measured in the last 15 months was 140/85 or less
11 40-70%
Percentage of patients on the register with hypertension and proteinuria treated with an ACE-I or ARB (unless side-effects are recorded)
4 40-80%
Percentage of patients on the register whose notes have a record of urine ACR or PCR in the previous 15 months
6 40-80%