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Chronic Kidney Disease, (Latest code), Aged 18 years and over

Includes

1Z12. Chronic kidney disease stage 3
1Z13. Chronic kidney disease stage 4
1Z14. Chronic kidney disease stage 5
1Z15. Chronic kidney disease stage 3A
1Z16. Chronic kidney disease stage 3B
1Z1B. Chronic kidney disease stage 3 with proteinuria
1Z1C. Chronic kidney disease stage 3 without proteinuria
1Z1D. Chronic kidney disease stage 3A with proteinuria
1Z1E. Chronic kidney disease stage 3A without proteinuria
1Z1F. Chronic kidney disease stage 3B with proteinuria
1Z1G. Chronic kidney disease stage 3B without proteinuria
1Z1H. Chronic kidney disease stage 4 with proteinuria
1Z1J. Chronic kidney disease stage 4 without proteinuria
1Z1K. Chronic kidney disease stage 5 with proteinuria
1Z1L. Chronic kidney disease stage 5 without proteinuria
K053. Chronic kidney disease stage 3
K054. Chronic kidney disease stage 4
K055. Chronic kidney disease stage 5

Excludes

1Z10. Chronic kidney disease stage 1
1Z11. Chronic kidney disease stage 2
1Z17. Chronic kidney disease stage 1 with proteinuria
1Z18. Chronic kidney disease stage 1 without proteinuria
1Z19. Chronic kidney disease stage 2 with proteinuria
1Z1A. Chronic kidney disease stage 2 without proteinuria

Chronic kidney disease exception reporting codes added in the previous 12 months.

9hE1. Excepted from chronic kidney disease quality indicators: Informed dissent
9hE0. Excepted from chronic kidney disease quality indicators: Patient unsuitable

The latest Systolic <=140 and Diastolic <=85

BP Exception code (Added in last 12 months)

8I3Y. Blood pressure procedure refused

Maximum BP therapy (In last 12 months)

8BL0. Patient on maximal tolerated antihypertensive therapy

BP Codes (In last 12 months)

246% O/E - blood pressure reading,

Excluding:

2460 O/E - BP unrecordable (v7)
2468. O/E - BP reading:postural drop
246H. O/E - Arterial pressure index normal
246I. O/E - Arterial pressure index abnormal
246K. Target systolic blood pressure
246L. Target diastolic blood pressure
246M. White coat hypertension
246h. Arterial pulse pressure
246i. Diastolic blood pressure centile
246j. Systolic blood pressure centile
246k. Unequal blood pressure in arms

In detail:

246. O/E - blood pressure reading
2461. O/E - BP reading very low
2462. O/E - BP reading low
2463. O/E - BP borderline low
2464. O/E - BP reading normal
2465. O/E - BP borderline raised
2466. O/E - BP reading raised
2467. O/E - BP reading very high
2469. O/E - Systolic BP reading
246A. O/E - Diastolic BP reading
246B. O/E - BP stable
246C. Lying blood pressure reading
246D. Standing blood pressure reading
246E. Sitting blood pressure reading
246F. O/E - blood pressure decreased
246G. O/E - BP labile
246J. O/E - BP reading: no postural drop
246N. Standing systolic blood pressure
246P. Standing diastolic blood pressure
246Q. Sitting systolic blood pressure
246R. Sitting diastolic blood pressure
246S. Lying systolic blood pressure
246T. Lying diastolic blood pressure
246Z. O/E-blood pressure reading NOS
246a. Average night interval diastolic blood pressure
246b. Average night interval systolic blood pressure
246c. Average home diastolic blood pressure
246d. Average home systolic blood pressure
246e. Ambulatory systolic blood pressure
246f. Ambulatory diastolic blood pressure
246g. Self measured blood pressure reading
246l. Average systolic blood pressure
246m. Average diastolic blood pressure
246n. Baseline blood pressure (v30)

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Chronic kidney disease 002.1 Rationale

Studies have shown that in people over 65 years and in people with diabetes, normal blood pressure is hard to achieve but is important (Anderson et al. American Journal of Kidney Disease 2005; 45(6): 994-1001).

The NICE CKD clinical guideline recommends that in people with CKD the clinician should aim to keep the systolic blood pressure below 140 mmHg (target range 120-139 mmHg) and the diastolic blood pressure below 90 mmHg. In people with CKD and diabetes, and also in people with an ACR 70 mg/mmol or more (approximately equivalent to PCR 100 mg/mmol or more, or urinary protein excretion 1g/24h or more) the clinician should aim to keep the systolic blood pressure below 130 mmHg (target range 120-129 mmHg) and the diastolic blood pressure below 80 mmHg.

The SIGN CKD clinical guideline recommends that blood pressure be controlled to slow the deterioration of the glomerular filtration rate and reduce proteinuria. Patients with >1g/day of proteinuria (approximately equivalent to a protein/creatinine ratio of 100 mg/mmol) should have a target maximum systolic blood pressure of 130 mmHg.

The lower the blood pressure achieved the better for patient care; 140/85 mmHg has been adopted for this indicator.

See also the latest British Hypertension Society guidelines 2004: Williams et al. J Hum HT 2004; 18: 139-185 (specific renal advice on pages 166-7). This suggests an “optimal” BP target in CKD of 130/80 or 127/75 if >1 g proteinuria. These targets in turn are derived from the Modification of Diet in Renal Disease study, (Klahr et al. NEJM 1994; 330: 877-884; Peterson et al. Ann Int Med 1995; 123: 754-762).

Further information
NICE clinical guideline 73 (2008). CKD in adults in primary and secondary care.
http://www.nice.org.uk/Guidance/CG73

SIGN clinical guideline 103 (2008). Diagnosis and management of CKD in adults.
http://www.sign.ac.uk/guidelines/fulltext/103/index.html

Chronic kidney disease 002.2: Reporting and verification

See indicator wording for requirement criteria.

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Prepared By Jean Keenan