A Critique of the UK NICE Guidance for the Detection and Management of Individuals with Chronic Kidney Disease

Abstract

The increasing global prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) has significant public health and economic implications. The recently published UK National Institute for Health and Clinical Excellence (NICE) clinical guidelines for the early identification and management of CKD provide a framework of disease management for both primary and secondary care with the stated aim of reducing the progression of CKD and the associated risk of cardiovascular death. Identification of at-risk individuals with proteinuria and inhibition of the renin-angiotensin system are the cornerstones of this strategy. However, the vast majority of patients with CKD will not develop ESRD and it is far from clear whether the NICE recommendations will reduce either ESRD or cardiovascular death associated with CKD.

Postoperative pain management in patients with chronic kidney disease

“…[ 1 2 3 ] Evaluation of kidney function is more dependent on GFR or the presence of other markers of kidney damage rather than a single serum creatinine (SCr) reading. [ 4 ] GFR can be estimated by using SCr using the Cockcroft–Gault equation to calculate the creatinine clearance (CCr). [ 5 ] Alternatively, it can be estimated through the Modification of Diet in Renal Disease (MDRD) study equation to provide the GFR where age is in years, and weight is in kilogram.…”

“…A structural abnormality in the kidney is present that is typically diagnosed incidentally during radiological investigations, such as the presence of kidney cyst. [ 1 2 4 ] Postoperative and posttraumatic pain management for these patients should not differ from other patients without kidney disease. [ 9 10 ] Analgesic plans should consider using neuraxial or peripheral nerve blockade whenever possible.…”

“…The level of renal function for these patients is sufficient for excretion of the drugs and their metabolites with no need for dose adjustment of pain medications. [ 1 2 3 4 ]…”

Effect of stem cells seeded onto biomaterial on the progression of experimental chronic kidney disease

“…1 Since the process of renal repair depends on the severity and extent of kidney injury and the number of resident stem cells, the recent development in cell-based therapies aiming to restore or replace chronically injured tissues may bring hope for the treatment of many chronic diseases. 2,3 However, there is a paucity of reports using bone marrow-derived cells (BMDC) as a regenerative therapy for chronic renal failure (CRF). Comparisons among the results are therefore jeopardized by study differences such as the use of different models of renal damage, the amount of administered cells and differences in the routes of cell administration.…”

Should Microalbuminuria Ever Be Considered as a Renal Endpoint in Any Clinical Trial

“…Thus, although data indicate that we can alter the progression of normoto microalbuminuria, micro-to macroalbuminuria, and macroalbuminuria to end-stage renal disease/death, we still lack a prospective trial to test the hypothesis that medical management of microalbuminuria affects patient-centered events independent of blood pressure reduction. Lastly, recent guideline statements by groups such as NICE [8] and regulatory agencies such as the Food and Drug Administration [9] have failed to accept microalbuminuria change as a surrogate for nephropathy progression.…”