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This publication is provided for historical reference only and the information may be out of date.

Cover of Chronic Kidney Disease

Chronic Kidney Disease

National Clinical Guideline for Early Identification and Management in Adults in Primary and Secondary Care

NICE Clinical Guidelines, No. 73


London: Royal College of Physicians (UK); .
ISBN-13: 978-1-86016-340-1


Publication of the second part of the Renal National Service Framework (NSF) served to emphasise the change in focus in renal medicine from treatment of established kidney disease to earlier identification and prevention of kidney disease. Allied to this is the knowledge that late referral of people with advanced kidney disease to nephrology services from both primary and secondary care is still at least as high as 30%, engendering increased mortality and morbidity and precluding assessment and preparation of those for whom conservative management is more appropriate.

Over 2% of the total NHS budget is spent on renal replacement therapy (dialysis and transplantation) for those with established renal failure. Strategies aimed at earlier identification and (where possible) prevention of progression to established renal failure are therefore clearly required. Equally importantly, population studies have shown that people with diagnosed chronic kidney disease (CKD) have a far greater likelihood of cardiovascular death than progression to established renal failure. Furthermore, the majority of people with CKD are asymptomatic and may not even be aware that they have any form of kidney problem.

The challenge is to: identify people with or at risk of developing CKD; determine who needs intervention to minimise cardiovascular risk and to determine what that intervention should comprise; determine who will develop progressive kidney disease and/or complications of kidney disease and how they may be identified and managed to reduce/prevent these outcomes; determine who needs referral for specialist kidney care. This requires adoption of an overall health approach and an integrated care strategy involving public awareness, professional education, policy influence, and improved care delivery systems all under-pinned by research.


Royal College of Physicians: The Royal College of Physicians plays a leading role in the delivery of high-quality patient care by setting standards of medical practice and promoting clinical excellence. We provide physicians in the United Kingdom and overseas with education, training and support throughout their careers. As an independent body representing over 20,000 Fellows and Members worldwide, we advise and work with government, the public, patients and other professions to improve health and healthcare.

National Collaborating Centre for Chronic Conditions: The National Collaborating Centre for Chronic Conditions (NCC-CC) is a collaborative, multiprofessional centre undertaking commissions to develop clinical guidance for the National Health Service (NHS) in England and Wales. The NCC-CC was established in 2001. It is an independent body, housed within the Clinical Standards Department at the Royal College of Physicians of London. The NCC-CC is funded by the National Institute for Health and Clinical Excellence (NICE) to undertake commissions for national clinical guidelines on an annual rolling programme.

Suggested citation:

National Collaborating Centre for Chronic Conditions. Chronic kidney disease: national clinical guideline for early identification and management in adults in primary and secondary care. London: Royal College of Physicians, September 2008.

Copyright © 2008, Royal College of Physicians of London.

All rights reserved. No part of this publication may be reproduced in any form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner. Applications for the copyright owner’s written permission to reproduce any part of this publication should be addressed to the publisher.

Bookshelf ID: NBK51773PMID: 21413194


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