The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Chronic Conditions have published a clinical guideline to improve treatment and care for people with anaemia associated with chronic kidney disease.
The new guideline advises on the detection and diagnosis of anaemia in people with chronic kidney disease, effective treatments, when treatment for anaemia should start, and how clinicians and patients should create a joint treatment plan.
A key recommendation is that age alone should not be a determinant for treatment of anaemia of chronic kidney disease. The guideline sets out target haemoglobin (Hb) levels in both adults and children, and levels of Hb at which specified therapies should be given. It also provides detailed advice on initiating, administering and adjusting for erythropoiesis-stimulating agent (ESA) treatment as appropriate.
The guideline recommends that androgens, and nutritional supplements such as vitamin C and folic acid, should not be given specifically to treat anaemia of chronic kidney disease as they don’t provide any extra benefit. However if these treatments are already being prescribed for other reasons, it is fine for patients to continue taking them. Routinely measuring erythropoietin levels for diagnosing or managing anaemia is also advised against.
Professor Peter Littlejohns, Clinical and Public Health Director at NICE and Executive Lead for the guideline, said: “This guideline will help improve the care and treatment of people with anaemia linked to chronic kidney disease. It provides recommendations for supporting patients, by providing information about anaemia of CKD, practical advice on managing their condition and access to a contact who will coordinate their treatment and care. It also gives clear best practice advice to health professionals on the most effective way to provide care, and our implementation advice will support that delivery.”
Dr David Halpin, Chair of the Guideline Development Group, said: “We are delighted to produce this guideline with NICE on managing anaemia linked to chronic kidney disease. Its aim is to improve standards of care across renal units and aid appropriate commissioning of cost effective treatments. This guideline sets standards for the best management of anaemia of chronic kidney disease, thus helping to end the existing variation in practice.”
Dr Paul Stevens, Clinical Advisor to the Guideline Development Group and Consultant Nephrologist, said: “Health professionals treating anaemia of chronic kidney disease in both secondary and primary care will be supported by the guideline. Implementation of part 2 of the renal NSF will see the balance of care for patients with chronic kidney disease predominantly in primary care settings. The guideline will help GPs and other health professionals in primary care understand what’s required to provide to best possible services for people with anaemia of chronic kidney disease. Clear step-by-step advice for health professionals and treatment algorithms provide guidance on management of this condition, whilst staff will decide how best to provide the recommended care in line with their local needs.”
Karen Jenkins, Guideline Development Group member and Renal Medicine Nurse Consultant, said: “The guideline highlights the importance of patient-centred care with recommendations for patient education programmes to explain the causes of anaemia, to provide details of professional support and to offer lifestyle advice. Individualising care for people with anaemia of chronic kidney disease will mean working closely with patients to take their specific needs and circumstances into account, for example in planning where and when treatments will be given. This guideline will support nursing staff in both primary and secondary care in improving the management of anaemia in people with chronic kidney disease.”
Notes
1. NICE is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.
2. NICE produces guidance in three areas of health:
public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS
clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
About the guidance:
3. The guidance is available at nice (from 00.01hrs, 27 September 2006)
4. NICE is currently working on the guideline “Early identification and management of adults with chronic kidney disease in primary and secondary care”. The progress of this guideline will be updated at nice/page.aspx?o=ChronicKidneyDisease
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The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.
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National Institute for Health and Clinical Excellence (NICE)