take the following steps to identify progressive CKD
obtain a minimum of three GFR estimations over a period of not less than 90 days
in people with a new finding of reduced eGFR, repeat the eGFR within 2 weeks to exclude causes of acute deterioration of GFR - for example, acute kidney injury or initiation of ACE inhibitor/ARB therapy
define progression as a decline in eGFR of more than 5 ml/min/1.73 m2 within 1 year, or more than 10 ml/min/1.73 m2 within 5 years
focus particularly on those in whom a decline of GFR continuing at the observed rate would lead to the need for renal replacement therapy within their lifetime by extrapolating the current rate of decline
NICE advise primary care clinicians should work with people who have risk factors for progression of CKD to optimise their health. These risk factors are:
cardiovascular disease
proteinuria
hypertension
diabetes
smoking
African, African-Caribbean or Asian family origin
chronic use of NSAIDs
urinary outflow tract obstruction
in people with CKD the chronic use of NSAIDs may be associated with progression and acute use is associated with a reversible fall in GFR
NICE suggest to exercise caution when treating people with CKD with NSAIDs over prolonged periods of time
in patients with NSAIDs, monitor the effects on GFR, particularly in people with a low baseline GFR and/or in the presence of other risks for progression
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