CREST Guidelines for Chronic Kidney Disease in Northern Ireland
Chronic kidney disease (CKD) imposes a large burden on health and health care resources in Northern Ireland. The enclosed guidelines reflect UK initiatives to recognise and manage CKD earlier in its course. These guidelines are based on those recently introduced by the Royal College of Physicians/Royal College of General Practitioners. They also reflect the National Service Framework for Renal Services and the recent addition of CKD as a clinical domain within the General Medical Services contract.
Established or end-stage renal failure (ERF) is relatively rare yet its treatment is disproportionately expensive with ~2% of the total NHS budget expended on dialysis and transplantation. The number of patients receiving dialysis in the UK is rising and is unlikely to reach steady state for another 25 years. The majority of patients starting dialysis have progressed from earlier stages of CKD and many could have been identified and referred earlier. Between 3-5% of the population have CKD therefore the great majority of such patients do not progress to established renal failure but many experience premature cardiovascular death. Importantly optimal management of the risk factors for cardiovascular disease also reduces the risk of progression from early CKD to ERF.
Since early CKD is common, and referral of all patients with early CKD would completely overwhelm existing specialist services, these guidelines suggest ways to identify and manage CKD in the community, reserving specialist referral for those with complex or progressive chronic kidney disease.
Under the auspices of the Clinical Resource Efficiency Support Team (CREST), a sub-group of health care professional, chaired by Dr Damien Fogarty and Professor Peter Maxwell was established to produce guidelines on Chronic Kidney Disease.
CREST would like to thank Dr Damien Fogarty and Professor Peter Maxwell for their contribution to the development of these guidelines. Thanks are also extended to Dr John C Harty, the members of the sub-group, the Northern Ireland Nephrology Forum and all those who contributed in any way to the production of these guidelines.
Further copies of the guidelines and wall chart can be obtained from the CREST Secretariat at crest@dhsspsni.gov.uk or gary.hannan@dhsspsni.gov.uk
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