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Overview

This COVID-19 rapid guideline aims to maximise the safety of adults with chronic kidney disease during the COVID-19 pandemic. It also aims to protect staff from infection and enable services to make the best use of NHS resources. This summary does not cover recommendations for patients with advanced chronic kidney disease. For the complete set of recommendations, please refer to the full guideline.

Communicating with patients and minimising risk

  • Communicate with patients, their families and carers, and support their mental wellbeing to help alleviate any anxiety they may have about COVID-19. Signpost to sources of information (such as Kidney Care UK coronavirus (COVID-19) guidance for patients with kidney disease, the National Kidney Federation coronavirus (COVID-19) information and advice for patients and local kidney patient organisations), support groups (including NHS Volunteer Responders) and UK government guidance on the mental health and wellbeing aspects of COVID-19
  • Some patients will have received a letter telling them they are at high risk of severe illness from COVID-19. Tell them:
  • Telephone, email or text patients booked for a nephrology appointment. Tell them:
  • Minimise face-to-face contact by:
    • using telephone, video or email consultations whenever possible
    • cutting non-essential face-to-face appointments
    • contacting patients via text message, telephone or email
    • using electronic prescriptions rather than paper
    • using different methods to deliver prescriptions and medicines, for example, pharmacy deliveries, postal services or NHS Volunteer Responders, or introducing drive-through pick-up points for medicines
  • Tell patients that they should contact the NHS 111 online coronavirus service if they think they have COVID-19. They should also contact their renal team (if they have one) for advice. In an emergency, they should call 999
  • If patients need to attend face-to-face appointments or for blood tests, ask them to help reduce the risk of contracting or spreading COVID-19 by:
    • following relevant parts of government advice on social distancing (this differs across the UK) 
    • coming to the appointment alone
    • having only 1 person accompany them if they cannot come alone
    • avoiding public transport if possible; if they must use public transport, suggest they wear a face covering
  • Use local services for blood tests where possible
  • Minimise time in the waiting area by:
    • careful scheduling
    • encouraging patients not to arrive early
    • texting or phoning patients when you are ready to see them, so that they can wait outside, for example, in their car
    • providing a ‘clean route’ through the hospital or clinic
    • delivering treatment promptly
    • ensuring prescriptions are dispensed rapidly

Patients known or suspected to have COVID-19

Managing chronic kidney disease (CKD)

Modifying usual care

  • Think about how to modify usual care to reduce patient exposure to COVID-19 and make best use of resources (workforce, facilities and equipment) while ensuring that services are available for patients
  • When modifying individual patients’ treatment plans:
    • take their preferences for care and treatment into account
    • take their clinical circumstances into account
    • involve all relevant members of the multidisciplinary team in the decision
    • record the reasoning behind each decision
  • Discuss the risks and benefits of changing treatment schedules or interrupting treatment with patients

Medicines

Monitoring CKD

  • Reassess renal function in patients with CKD who have recovered from COVID-19. Base the urgency of reassessment on the patient’s GFR category, comorbidities and clinical circumstances
  • For patients who are stable on treatment, assess whether it is safe to reduce the frequency of routine blood and urine tests during the COVID-19 pandemic. Take into account any comorbidities and whether their CKD is progressive. (NICE’s guideline on chronic kidney disease provides recommendations on the frequency of routine monitoring)
  • Encourage self-monitoring and self-management (including blood pressure monitoring) for patients who are able to do this. Give them access to their medical data (including diagnosis, comorbidities, test results, treatments and correspondence) through information systems such as PatientView or primary care electronic records systems
  • Ensure that patients who are self-monitoring or self-managing know when they should seek help and who to contact

Specialist services

Referrals to renal services

  • To minimise risk from COVID-19, delay referral if the clinical need is not urgent, for example, if the patient has mild to moderate proteinuria and a stable GFR (including patients with suspected inherited kidney disease)
  • Continue to refer patients for urgent outpatient appointments if there is a clinical need, for example, if the patient has:
    • accelerated progression of CKD, defined as:
      • a sustained decrease in GFR of 25% 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
    • nephrotic syndrome or very severe proteinuria (urinary ACR more than 300 mg/mmol)
    • a new diagnosis of GFR category G5 (GFR less than 15 ml/min/1.73 m2)
  • Contact the renal team by telephone or virtually if there is uncertainty about the need for an urgent outpatient referral

Renal ultrasound

  • To minimise risk from COVID-19, delay referral for renal ultrasound if the result is unlikely to change management immediately, for example, if the patient has:
    • a family history of polycystic kidney disease and needs renal ultrasound to exclude this disease
    • a GFR less than 30 ml/min/1.73 m2 (GFR category G4 or G5) that has been stable for at least 6 months
    • been identified by a nephrologist as having a possible need for a non-urgent renal biopsy
  • Continue to refer patients for renal ultrasound if the result might immediately change management, for example, if the patient has:
    • accelerated progression of CKD (see the recommendation on referring patients for urgent outpatient appointments if there is a clinical need, under ‘Referrals to renal services’, above)
    • visible or persistent invisible haematuria
    • symptoms of urinary tract obstruction
    • been identified by a nephrologist as needing an urgent renal biopsy

Hospital admission

  • When deciding whether to refer a patient with CKD and COVID-19 for hospital admission, discuss with the admitting clinician and take into account:
    • the patient’s preferences
    • the severity of the CKD and any comorbidities
    • whether the patient is taking immunosuppressants
    • the benefits and risks of admission
    • the care that can be offered in hospital compared with that at home

© NICE 2020. COVID-19 rapid guideline: chronic kidney disease. Available from: nice.org.uk/guidance/ng176. All rights reserved. Subject to Notice of rights.

NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.

Published date: 15 May 2020.