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About KidneyWise

The KidneyWise Clinical Toolkit promotes person-centered and high-quality primary care in chronic kidney disease (CKD) across Ontario. It provides primary care providers with:

  • guidance on the identification, detection and management of people with chronic kidney disease in primary care
  • guidance on who will likely benefit from a referral to nephrology
  • recommendations on identifying people at high risk of developing chronic kidney disease, ordering appropriate tests to confirm diagnosis, and how best to manage the disease to help prevent further progression and reduce cardiovascular risk

What’s in KidneyWise

Clinical Algorithm

  • Provides guidance on the identification, detection and management of people with chronic kidney disease
  • Can be used at the point of care

Evidence Summary

  • Offers more details and references that were used to develop the toolkit
  • Can be used to gain insight on the evidence used for the algorithm

Outpatient Nephrology Referral Form

  • Highlights clinical scenarios that may require consultation with a nephrologist
  • Can be used as a guide for appropriate referral criteria and applied to your current referral system

What’s New

KidneyWise was updated in 2018 based on new evidence from clinical practice guidelines (e.g., Hypertension Canada, Diabetes Canada) and feedback from clinical providers.

  • Addition of First Nations, Inuit and Métis people(s) ≥ 18 years of age as a high risk group that should be screened for chronic kidney disease in the Identify & Evaluate section of the clinical algorithm
  • Changes to blood pressure treatment targets for people with chronic kidney disease and hypertension in the Manage section of the clinical algorithm
  • Changes to the recommendations for referral to nephrology, which now includes a 5 year ≥ 5% probability of progression to end-stage kidney disease using the Kidney Failure Risk Equation (KFRE) in the Detect section of the clinical algorithm

Additional Resources

  • Medication Safety List – Find a list of medications commonly prescribed in primary care that should be avoided or dose-adjusted for people with chronic kidney disease
  • eConsult – Do you have questions about your patient that you would like to ask a nephrologist? Sign-up for the Ontario eConsult Program and ask one of the 40+ nephrologists registered. Feedback on the program has been very positive from referring healthcare providers, specialists and patients. Email eConsultCOE@toh.ca to learn how to make eConsult a regular part of your practice.

Acknowledgements

KidneyWise has been vetted and endorsed by nephrologists and primary care providers within Ontario and across Canada. The toolkit will be reviewed regularly to ensure that it reflects the latest evidence.

Guidelines Referenced to Develop KidneyWise

Levin A, Hemmelgarn B, Culleton B, Tobe S, McFarlane P, Ruzicka M, et al. Guidelines for the Management of Chronic Kidney Disease. CMAJ [Internet].2008 Nov [cited 2018 May 10]; 179(11): 1154-1162.

Collins AJ, Vassalotti JA, Wang C, Li S, Gilbertson DT, Liu J, Foley RN, Chen SC, Arneson TJ. Who Should Be Targeted for CKD Screening? Impact of Diabetes, Hypertension, and Cardiovascular Disease. Am J Kidney Dis 2009 Mar 53(S3): S71-S77.

Kidney Disease Improving Global Outcomes [Internet]. CKD Guidelines; 2012. [Cited 2018 May 11].

Tangri B, Stevens L, Griffith J et al. A Predictive Model for Progression of Chronic Kidney Disease to Kidney Failure. JAMA [Internet]. 2011 Apr 11. [Cited 2018 May 10]. 305(15): 1553-9.

Acedillo RR, Tangri N, Garg AX. The kidney failure risk equation: on the road to being clinically useful? Nephrology Dialysis Transplantation [Internet]. 2013 July [cited 2018 May 10]; 28(7): 1623-4.

Kidney Disease Improving Global Outcomes [Internet]. Clinical Practice Guideline for Lipid Management in CKD; 2013. [Cited 2018 May 11].

Nerenberg KA, Zarnke KB, Leung AA, Dasgupta K, Butalia S, McBrien K et al. Hypertension Canada's 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children. Canadian Journal of Cardiology. [Internet]. 2018 May [cited 2018 May 10]; 34 (5):506-525.

Canadian Diabetes Association [Internet]. Clinical Practice Guidelines; 2018. [Cited 2018 May 11].

A Randomized Trial of Intensive versus Standard Blood-Pressure Control. The SPRINT Research Group. N Engl J Med. 2015 Nov 373: 2103-2116.

Zia A, Kamaruzzaman SB, & Tan MP. Polypharmacy and falls in older people: Balancing evidence-based medicine against falls risk. Postgrad Med 2014 Dec 127(3): 330-7.

Ruzicka M, Edwards C, McCormick B, Hiremath S. Thus Far and No Further: Should Diastolic Hypotension Limit Intensive Blood Pressure Lowering? Curr Treat Options Cardio Med 2017 Sep 19 (10):80.

Public Health Agency of Canada [Internet]. Toronto: For Health Professional Flu (Influenza) [cited 2018 May 15].