NICE guidelines: chronic kidney disease and COVID-19

  • National Institute for Health and Care Excellence

  • curated by Dawn O'Shea
  • Clinical Guidance Summaries
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NICE has published guidelines to maximise the safety of adults with chronic kidney disease (CKD) during the COVID-19 pandemic. Here, we provide a summary of the key recommendations.

General recommendations

  • Communicate patients/families/carers, and support their mental well-being.
  • Provide advice on shielding and protecting.
  • Minimise face-to-face contact.
  • If a face-to-face appointment is needed, screen patient by phone on the day of the appointment and again on arrival (including temperature check).
  • Patients should attend appointments with no more than one other person.
  • Minimise time in the waiting area, e.g., text patients when you are ready to see them so that they can wait in the car.
  • Instruct patients due for a nephrology appointment to continue taking their medication unless advised otherwise by their health care professional.

Patients with known or suspected COVID-19

  • Follow UK guidance on infection prevention and control for COVID-19.
  • If COVID‑19 is later diagnosed in a patient not isolated from admission or presentation, follow guidance on the management of exposed health care workers and patients in health care settings.
  • If a patient not previously known or suspected to have COVID‑19 shows symptoms at presentation, follow UK guidance on investigation and initial clinical management of possible cases.

Modifying usual care

  • Consider modifications to usual care to reduce patient exposure to COVID‑19.
  • Discuss the risks and benefits of changing or interrupting treatment schedules.

Medicines

  • Advise patients to continue taking their medicines (including angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), immunosuppressants and diuretics) as normal, unless advised to stop by their health care professional. This includes patients who have symptoms of COVID‑19.
  • There is no high-quality evidence that ACE inhibitors or ARBs worsen COVID‑19.
  • For patients with CKD and suspected or confirmed COVID‑19, review medicines for any potential to adversely affect renal function.

Monitoring CKD

  • Reassess renal function in patients with CKD who have recovered from COVID‑19.
  • For patients who are stable on treatment, assess whether it is safe to reduce the frequency of blood and urine tests.
  • Encourage self-monitoring and self-management.

Referral to renal services

  • To minimise risk from COVID‑19, delay non-urgent referral.
  • Continue to refer patients for urgent outpatient appointments if there is a clinical need, for example:
  1. Accelerated progression of CKD, defined as:
    • a sustained decrease in glomerular filtration rate (GFR) of 25 per cent or more and a change in GFR category within 12 months or
    • a sustained decrease in GFR of 15 mL/min/1.73 m2 per year.
  2. Nephrotic syndrome or very severe proteinuria (urinary albumin to creatinine ratio more than 300 mg/mmol).
  3. A new diagnosis of GFR category G5 (GFR less than 15 mL/min/1.73 m2).
  • Contact the renal team if there is uncertainty about urgency.

Ultrasound

  • To minimise the risk, delay referral if the result is unlikely to change management immediately, for example, if the patient has:
  1. a family history of polycystic kidney disease and needs renal ultrasound to exclude this disease;
  2. a GFR less than 30 mL/min/1.73 m2 (GFR category G4 or G5) that has been stable for ≥6 months; and
  3. been identified by a nephrologist as having a possible need for a non‑urgent renal biopsy.
  • Refer if the result might immediately change management, for example, if the patient has:
  1. accelerated progression of CKD,
  2. visible or persistent invisible haematuria,
  3. symptoms of urinary tract obstruction, and
  4. been identified by a nephrologist as needing an urgent renal biopsy.

Advanced CKD

  • Continue to plan and carry out procedures to create vascular and peritoneal access for patients who will be starting dialysis.
  • Consider whether it is safe to delay starting dialysis.
  • Continue to refer patients for transplantation, if suitable.
  • Ensure patients with advanced CKD have the opportunity to participate in advance care planning.