Chronic Kidney Disease Management: BC Guidelines

This tool is intended to simplify, not replace, use of the BC Chronic Kidney Disease guidelines. By providing outputs based on patient-specific factors, we hope to provide an educational tool that makes the guidelines simpler to apply at the point of care.

Please note, blood pressure targets are presented based on the BC Chronic Kidney Disease guidelines as well as other guidelines such as those developed by CHEP and KDIGO.

For patients at high risk of atherosclerotic events, the 2013 KDIGO guidelines recommend lifestyle changes and cholesterol-lowering treatment with low dose statin therapy, without target levels of LDL. Reduction of LDL from baseline irrespective of the value is the goal. Note: see KDIGO Lipid Management guideline for caveats at kdigo.org/home/guidelines/lipids/

The tool provides guidance on need for referral to a specialist based on GFR and proteinuria, but here is a more detailed set of clinical parameters that could prompt referral:

1. Presence of active urine sediments (red blood cell casts or cellular casts), constitutional symptoms, or unexplained severity of kidney dysfunction
2. AKI or abrupt sustained fall in eGFR
3. GFR <30 mL/min
4. Persistent finding of ACR >30 mg/mmol
5. Rapid and sustained deterioration in kidney function (a decline of eGFR >10-15% within 12 month period) warrants urgent referral to a nephrologist or internist, irrespective of eGFR values.
6. Progressive CKD
7. CKD and hypertension refractory to treatment
8. Persistent elevation of potassium
9. Hereditary kidney disease
10. No obvious etiology for kidney disease and knowing etiology may impact care plan.