Chronic Kidney Disease Clinical Pathway

Testing for CKD should not be universal, but should be targeted for individuals at increased risk of developing CKD:

• Hypertension
• Diabetes Mellitus
• Family history of Stage 5 CKD or hereditary kidney disease
• Vascular disease (prior diagnosis of CVD, stroke/TIA or PVD)
• Multisystem disease with potential kidney involvement (e.g. SLE)

• Best measure of kidney function.
• eGFR <60mL/min/1.73m² for ≥ 3 months is diagnostic for CKD.
• eGFR may be unreliable in certain situations including:
  • » acute changes in kidney function; extremes in body size; diseases affecting skeletal muscle; paraplegia, amputees or high muscle mass; severe liver disease; drugs interacting with creatinine excretion (Trimethoprim, Fenofibrate).

Random urine albumin:creatinine ratio (ACR):

• Excess amounts of protein in urine are a marker of kidney damage and increase kidney disease and CVD risk.
• A random urine ACR is preferred to detect proteinuria (ideally first morning void).
• ACR has greater sensitivity than protein:creatinine ratio (PCR) for low levels of proteinuria.
• ACR ≥3.0 mg/mmol for both men and women is clinically significant.

Approximate equivalent values of ACR, PCR and urinary protein excretion:

In patients with a new finding of reduced eGFR, retest eGFR to exclude causes of acute deterioration of eGFR (e.g. acute kidney injury, or initiation of ACEi or ARB therapy).

In patients with a previous finding of an abnormal eGFR and ACR in the past 6 months, you do not have re-test.

In patients with a new finding of reduced eGFR, retest eGFR to exclude causes of acute deterioration of eGFR (e.g. acute kidney injury, or initiation of ACEi or ARB therapy).

In patients with a previous finding of an abnormal eGFR and ACR in the past 6 months, you do not have re-test.