Making Best Practice, Every Day Practice
Heart failure (HF) is a devastating clinical syndrome characterised by a constellation of symptoms and signs in the presence of reduced cardiac function. Comorbidity is almost inherent as HF is often the culmination of chronic disease processes such as ischaemic heart disease, hypertension and valve disease and its treatment may precipitate comorbidities such as gout, erectile dysfunction (ED) and acute kidney injury (AKI).
About one fifth of people admitted to hospital each year as emergencies have acute kidney injury (AKI), and about two thirds of AKI starts in the community. These two useful wallcharts provide essential advice for GPs and practice nurses on how to recognise and respond to AKI in adults.
This article seeks to demonstrate the close relationship between cardiovascular disease and chronic kidney disease (CKD). It also highlights the importance of identifying people with CKD as a means of recognising people at high risk of both cardiovascular events and unplanned admissions.
Ischaemic or coronary heart disease is the single leading cause of death in any Western population but more critically is one of the leading causes of premature deaths (i.e. deaths 75 years) in both men and women. There are numerous risk factors for ischaemic heart disease and understanding these and other comorbidities is critical to achieving optimal outcomes.
This month’s Back to Basics feature is a useful wallchart showing the five key functions of the kidney which include making balancing salt and water levels, making strong bones, boosting the production of red blood cells, controlling blood pressure and excreting waste from the blood.
Chronic kidney disease (CKD) is the term used to describe long-lasting abnormal kidney function and/or structure. It is common and often exists together with other conditions like cardiovascular disease (CVD) and diabetes. CKD is an essential diagnosis because treatment can reduce the risk of CVD and prevent or slow progression to kidney failure. This is your briefing on important NICE guideline changes that will help us to better identify at-risk patients while making over-diagnosis less likely.
Since the publication in 2008 of the first NICE guideline on the diagnosis and management of chronic kidney disease (CKD), there has been concern that creatinine-based estimated glomerular filtration rate (eGFR) may not accurately identify people at increased risk–particularly in elderly populations. The updated NICE guideline, issued in July 2014, includes some important changes that take into account recent research into the prognosis of CKD. Of particular relevance for GPs are changes to the diagnostic criteria and classification of CKD, which are described in this article.
This article describes the interrelationship between chronic kidney disease (CKD) and cardiovascular disease and defines the basis for the various interventions which have been recommended in national guidelines. It also provides a critique of currently available guidelines and suggests where changes may be desirable in future.
Chronic kidney disease (CKD) is increasing worldwide. The aim of this study was to identify factors related to progression of chronic kidney disease in a primary care service. Risk factors for progression of CKD were: diabetes, hypertension, uncontrolled systolic pressure and basal creatinine.
Some patients with advanced kidney disease may prefer not to receive treatment with dialysis. Conservative management describes the care designed to relieve these patients’ symptoms and maximise their health during their remaining months or years. By working with local renal and palliative services, practice nurses and other primary healthcare professionals will play a major role in ensuring a good death for kidney patients opting for conservative management.
Acute kidney injury (AKI) is becoming increasingly common. Patients at greatest risk are the elderly with chronic kidney disease (CKD) and other long-term conditions such as hypertension, diabetes and cardiovascular disease. AKI carries a poor prognosis yet 30% of cases are preventable. In primary care we can help prevent AKI by empowering patients to take drug holidays—that is, temporarily stopping medications that become harmful to the kidneys during episodes of acute illness.
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