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Codes for Albumin:Creatinine & Protein:Creatinine Ratio for CKD( Added in the last 12 months)

44lD. Urine protein/creatinine ratio
46TC. Urine albumin:creatinine ratio
46TD. Urine microalbumin:creatinine ratio
44lzX Random urine protein:creatinine ratio (v30)

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

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

Excliusion Code for declines to give urine specimen added in the previous 12 months

9RX.. Declines to give urine specimen (v26)

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

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Chronic kidney disease 004.1 Rationale

Quantitative measurement of proteinuria will enable appropriate management of patients with CKD. There is good observational evidence linking proteinuria to adverse outcomes.

NICE recommends the use of ACE inhibitors when there is hypertension and an ACR of .30mg/mmol. When ACR .70mg/mmol NICE recommends ACE inhibitors are prescribed; even in the absence of hypertension.

SIGN recommends the use of ACE inhibitors and/or ARBs as agents of choice in patients with proteinuria >0.5g/day (approximately equivalent to a PCR of >50mg/mmol).

As with Blood Pressure there are stricter standards for those with diabetes; ACR >2.5mg/mmol in men and >3.5mg/mmol in women - with or without hypertension.

www.nice.org.uk/Guidance/CG73

www.sign.ac.uk/guidelines/fulltext/103/index.html

Chronic kidney disease 004.2 Reporting and verification

See indicator wording for requirement criteria.

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Prepared By Jean Keenan