Clinical Practice Guidelines
2.0.0-ballot - ballot
Clinical Practice Guidelines
2.0.0-ballot - ballot
This page is part of the Clinical Guidelines (v2.0.0-ballot: STU2 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions
| Active as of 2023-12-19 |
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<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: PlanDefinition</b><a name="cc-cpg-plan-ckd"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource PlanDefinition "cc-cpg-plan-ckd" </p><p style="margin-bottom: 0px">Profiles: <a href="StructureDefinition-cpg-ordersetdefinition.html">CPG Order Set Definition</a>, <a href="StructureDefinition-cpg-computableplandefinition.html">CPG Computable Plan Definition</a></p></div><p><b>CQF Knowledge capability</b>: shareable</p><p><b>CQF Knowledge capability</b>: computable</p><p><b>CQF Knowledge capability</b>: publishable</p><p><b>CQF knowledge representation level</b>: structured</p><p><b>StructureDefinition Work Group</b>: cds</p><p><b>url</b>: <code>http://hl7.org/fhir/uv/cpg/PlanDefinition/cc-cpg-plan-ckd</code></p><p><b>version</b>: 2.0.0-ballot</p><p><b>name</b>: ChronicKidneyDiseaseAmbulatory</p><p><b>title</b>: Chronic Kidney Disease - Ambulatory Plan Definition</p><p><b>type</b>: Order Set <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-plan-definition-type.html">PlanDefinitionType</a>#order-set)</span></p><p><b>status</b>: active</p><p><b>experimental</b>: true</p><p><b>date</b>: 2023-12-19 19:53:17+0000</p><p><b>publisher</b>: HL7 International / Clinical Decision Support</p><p><b>contact</b>: HL7 International / Clinical Decision Support: <a href="http://www.hl7.org/Special/committees/dss">http://www.hl7.org/Special/committees/dss</a></p><p><b>description</b>: Chronic Kidney Disease - Ambulatory</p><h3>UseContexts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style="display: none">*</td><td>Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')</td><td>Chronic kidney disease (disorder) <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#709044004)</span></td></tr></table><p><b>jurisdiction</b>: World <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (m49.htm#001)</span></p><p><b>copyright</b>: Copyright © Elsevier, and others.</p><p><b>topic</b>: Treatment <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-definition-topic.html">DefinitionTopic</a>#treatment)</span></p><blockquote><p><b>relatedArtifact</b></p><p><b>type</b>: justification</p><p><b>display</b>: SYNOPSIS - Chronic Kidney Disease
KEY POINTS
Decline in function of the kidney characterized by at least 3 months of reduced GFR (less than 60 mL/minute/ 1.73 m&sup2;) or at least 3 months of structural or functional kidney damage
Assessment of both GFR and albuminuria is necessary to diagnose chronic kidney disease and monitor disease progression
GFR is most commonly estimated through measuring serum creatinine and the use of GFR estimating equations, either the Modification of Diet in Renal Disease Study equation or the Chronic Kidney Disease Epidemiology Collaboration equation
Albuminuria is measured by urine albumin/creatinine ratio; greater than 30 mg/g indicates albuminuria
Chronic kidney disease is commonly associated with hypertension, diabetes, and cardiovascular disease
First line therapy includes ACE inhibitors and/or angiotensin II receptor blockers to reduce albuminuria and hypertension
If left untreated, chronic kidney disease can progress to end-stage renal disease requiring dialysis or renal transplant
Symptoms of end-stage renal disease (eg, pruritus, refractory electrolyte imbalances, metabolic acidosis, severe nausea, neurologic impairments) typically occur when GFR is 5 to 10 mL/minute/1.73 m&sup2;
Carefully monitor electrolyte levels, hemoglobin, parathyroid hormone levels, and sodium bicarbonate levels to detect complications of chronic kidney disease, including cardiovascular disease, anemia, bone mineral disease, and metabolic acidosis
URGENT ACTION
Hyperkalemia may require urgent treatment in patients being treated for chronic kidney disease
Urgent treatment consists of calcium chloride or calcium gluconate and regimens of sodium bicarbonate, glucose and insulin, or nebulized albuterol
PITFALLS
Early stages are often asymptomatic, causing chronic kidney disease to be untreated, leading to further progression of kidney damage and worse prognosis</p><p><b>citation</b>: Chronic Kidney Disease Clinical Overview. ClinicalKey. Source</p><p><b>url</b>: <a href="http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75E10232E05352E3610A5325">http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75E10232E05352E3610A5325</a></p><blockquote><p><b>document</b></p></blockquote></blockquote><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>cc-cpg-activity-referral-nephrology</blockquote><p><b>title</b>: Referrals</p><p><b>groupingBehavior</b>: visual-group</p><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>34387224</blockquote><p><b>title</b>: Referral: Nephrology; History: [add diagnosis, symptom(s)]; Question: [add reason for referral]</p><p><b>description</b>: Referrals</p><p><b>requiredBehavior</b>: could</p><p><b>precheckBehavior</b>: no</p><p><b>definition</b>: <a href="ActivityDefinition-cc-cpg-activity-referral-nephrology.html">Referral: Nephrology; History: [add diagnosis, symptom(s)]; Question: [add reason for referral]</a></p></blockquote><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>cc-cpg-activity-referral-dietition</blockquote><p><b>title</b>: Referral: Dietitian; History: chronic kidney disease; Question: [add reason for referral]</p><p><b>description</b>: Referrals</p><p><b>requiredBehavior</b>: could</p><p><b>precheckBehavior</b>: no</p><p><b>definition</b>: <a href="ActivityDefinition-cc-cpg-activity-referral-dietitian.html">Referral: Dietitian; History: chronic kidney disease; Question: [add reason for referral]</a></p></blockquote></blockquote></div>
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KEY POINTS
Decline in function of the kidney characterized by at least 3 months of reduced GFR (less than 60 mL/minute/ 1.73 m&sup2;) or at least 3 months of structural or functional kidney damage
Assessment of both GFR and albuminuria is necessary to diagnose chronic kidney disease and monitor disease progression
GFR is most commonly estimated through measuring serum creatinine and the use of GFR estimating equations, either the Modification of Diet in Renal Disease Study equation or the Chronic Kidney Disease Epidemiology Collaboration equation
Albuminuria is measured by urine albumin/creatinine ratio; greater than 30 mg/g indicates albuminuria
Chronic kidney disease is commonly associated with hypertension, diabetes, and cardiovascular disease
First line therapy includes ACE inhibitors and/or angiotensin II receptor blockers to reduce albuminuria and hypertension
If left untreated, chronic kidney disease can progress to end-stage renal disease requiring dialysis or renal transplant
Symptoms of end-stage renal disease (eg, pruritus, refractory electrolyte imbalances, metabolic acidosis, severe nausea, neurologic impairments) typically occur when GFR is 5 to 10 mL/minute/1.73 m&sup2;
Carefully monitor electrolyte levels, hemoglobin, parathyroid hormone levels, and sodium bicarbonate levels to detect complications of chronic kidney disease, including cardiovascular disease, anemia, bone mineral disease, and metabolic acidosis
URGENT ACTION
Hyperkalemia may require urgent treatment in patients being treated for chronic kidney disease
Urgent treatment consists of calcium chloride or calcium gluconate and regimens of sodium bicarbonate, glucose and insulin, or nebulized albuterol
PITFALLS
Early stages are often asymptomatic, causing chronic kidney disease to be untreated, leading to further progression of kidney damage and worse prognosis"/>
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IG © 2023+ HL7 International / Clinical Decision Support. Package hl7.fhir.uv.cpg#2.0.0-ballot based on FHIR 4.0.1. Generated 2023-12-19
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