Donal O’Donoghue
Consultant Nephrologist, Salford
& Chair of The Renal Advisory Group
The Renal
NSF places people with Chronic Kidney Disease (CKD) firmly at the centre of
both service planning and delivery. Part two was published in February 2005.1
It covers prevention, early identification and management of CKD as well as
aspects of acute renal failure (ARF) and end of life care. Together with Part
One they cover the entire patient pathway.
The Kidney
Disease Outcomes Quality Initiative (KDOQI) classification based on Glomerular
Filtration Rate (GFR) has been adopted. 1 This will require
automatic reporting of estimated GFR (eGFR) by all clinical biochemistry
laboratories. In adults a normal GFR is +/- 100mils/min and therefore eGFR can
be considered akin to percentage kidney function.2
Part Two
of the Renal NSF includes four quality requirements (outlined below) and 23
markers of good practice.
1 Prevention
and early detection of CKD. People at risk of developing CKD, or those who have
undiagnosed CKD, should be identified and assessed, and their condition
managed.
2 Minimising
the progression and consequences of CKD. People with a diagnosis of CKD should
receive timely investigation, treatment and follow-up to reduce the risk of
progression and complications.
3 Acute renal failure. People at risk of, or suffering
from, acute renal failure should be identified promptly, with hospital services
delivering high-quality, clinically appropriate care in partnership with
specialist renal teams.
4 End-of-life-care.
People with established renal failure should receive timely evaluation of their
prognosis, information about the choices available to them and, for those near
the end of life, a jointly agreed palliative care plan.1
The NSF
recognises that as many as 5% of adults have an eGFR of below 60 mls/min and
are in Stages 3–5 of CKD. People with CKD are at increased risk of vascular
disease: optimising cardio-vascular risk reduction is one of the key goals of
the NSF. The guidelines for the identification, management and referral of
adults with CKD from the Royal College of Physicians, The Royal College of
General Practitioners and the Association of Clinical Biochemists provide the
further detail to the NSF’s overarching policy.1
Integrating
the delivery of the three vascular NSFs – Renal, Diabetes and Coronary Heart
Disease will be a major challenge for the healthcare community. It will require
integrated information technology and human resource development and a cultural
shift to long term conditions models of care. Benefits of demystifying CKD –
thinking and talking in eGFR, include preventative dividends in terms of
cardio-vascular and renal morbidity and offer the opportunity of structured
care for those who develop Stages 4 and 5 CKD.
References
1.
National Service Framework for Renal Services – Part Two:
Chronic kidney disease, acute renal failure and end of life care, DoH, 2005.
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