{"id":4780,"date":"2023-05-11T10:23:04","date_gmt":"2023-05-11T09:23:04","guid":{"rendered":"https:\/\/cdrc.nhs.uk\/?page_id=4780"},"modified":"2023-11-28T10:59:33","modified_gmt":"2023-11-28T10:59:33","slug":"systmone-diabetic-kidney-disease","status":"publish","type":"page","link":"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/","title":{"rendered":"SystmOne Diabetic Kidney Disease"},"content":{"rendered":"\n<p>Diabetic kidney disease (DKD) is usually a clinical diagnosis in a patient with long-standing diabetes (&gt;10 years) with albuminuria and\/or reduced estimated glomerular filtration rate (eGFR) in the absence of signs or symptoms of other primary causes of kidney damage.&nbsp;<\/p>\n\n\n\n<p>Prevention of development\/progression of DKD is helped by &#8216;standard&#8217; interventions that also prevent macrovascular disease e.g.,&nbsp;<\/p>\n\n\n\n<ul><li>Smoking Cessation&nbsp;<\/li><li>BP Control&nbsp;<\/li><li>Lipid Modification&nbsp;<\/li><li>Hyperglycaemia Management&nbsp;<\/li><\/ul>\n\n\n\n<p>Specific interventions are also recommended for patients with diabetes and a persistently raised ACR&gt;=3 (ACEi\/A2RB and SGLT2i).&nbsp;<\/p>\n\n\n\n<p>The following resources will help deliver these interventions:<\/p>\n\n\n\n<div style=\"height:10px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-genesis-blocks-gb-accordion gb-block-accordion\"><details><summary class=\"gb-accordion-title\">Managing\/ Preventing Diabetic Albuminuria<\/summary><div class=\"gb-accordion-text\">\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Intervention&nbsp;<\/strong><\/td><td><strong>Workload&nbsp;<\/strong><\/td><td><strong>Realistic timeframe&nbsp;<\/strong><\/td><td><strong>Staff&nbsp;<\/strong><\/td><td><strong>Action&nbsp;<\/strong><\/td><td><strong>Search&nbsp;<\/strong><\/td><\/tr><tr><td>Improving ACR testing uptake&nbsp;<\/td><td>Run batch searches at regular intervals e.g., fortnightly&nbsp;<\/td><td>Ongoing&nbsp;<\/td><td>Reception, care &#8211; coordinator&nbsp;<\/td><td>Contact patient by phone, SMS or email.&nbsp;<\/td><td>ACR Uptake for Diabetics&nbsp;&#8211; See below<\/td><\/tr><tr><td>Improve coding of albuminuria&nbsp;<\/td><td>Moderate amount of upfront work (often 5-10% of diabetic patients) followed by ongoing small amount of work&nbsp;<\/td><td>1 month&nbsp;<\/td><td>GP, nurse practitioner, pharmacist&nbsp;<\/td><td>Review record and consider adding appropriate code&nbsp;&nbsp;<\/td><td>Albuminuria Coding for Diabetics&nbsp;&#8211; See below<\/td><\/tr><tr><td>Improving detection of significant albuminuria&nbsp;<\/td><td>Moderate amount of upfront work (often 5-10% of diabetic patients) followed by ongoing steady stream of work&nbsp;<\/td><td>3 months&nbsp;<\/td><td>All staff&nbsp;<\/td><td>Review record and consider repeating ACR&nbsp;<\/td><td>Albuminuria Detection for Diabetics&nbsp;&#8211; See below<\/td><\/tr><tr><td>Improving management of diabetic albuminuria&nbsp;<\/td><td>(Usually) large amount of upfront work with smaller amount of ongoing work&nbsp;<\/td><td>3 months&nbsp;<\/td><td>GP, nurse practitioner, pharmacist (? Suitable trained others e.g. pharmacy technician, practice nurse)&nbsp;<\/td><td>Consider prescribing ACEi\/A2RB or recording reason why not&nbsp;<\/td><td>ACEi\/A2RB Treatment for DKD&nbsp;&#8211; See below<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><strong>* NB &#8211; patients who have newly coded albuminuria may become eligible for ACEi\/A2RB treatment, one of the diabetes QoF indicators.&nbsp; This process is best avoided towards the end of the QoF year.&nbsp;<\/strong><\/p>\n<\/div><\/details><\/div>\n\n\n\n<div style=\"height:10px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-genesis-blocks-gb-accordion gb-block-accordion\"><details><summary class=\"gb-accordion-title\">ACR Uptake for Diabetics\u00a0<\/summary><div class=\"gb-accordion-text\">\n<p>Improving the uptake of ACR testing in patients with diabetes is an important step to improving Diabetes care and prevent of micro and macrovascular morbidity and mortality.&nbsp;<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2023\/05\/image-3.png\" alt=\"\" class=\"wp-image-6394\" width=\"1053\" height=\"279\"\/><\/figure><\/div>\n\n\n\n<p>The two reports highlighted above identify diabetic patients who appear to be overdue ACR testing.&nbsp;The second report provides a more subtle approach and works well if added to an&nbsp;<a href=\"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/getting-started\/getting-started-how-tos\/\" target=\"_blank\" rel=\"noreferrer noopener\">Automated Reporting<\/a>&nbsp;batch that runs at regular intervals to report to reception or care-coordinators.&nbsp;&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Report<\/strong> <strong>Name<\/strong><\/td><td><strong>Returns<\/strong><\/td><td><strong>Actions<\/strong><\/td><\/tr><tr><td>? DM 3.201 Nephropathy &#8211; ACR not done in last 13m (unless excepted)&nbsp;<\/td><td>Patients with diabetes without a record of ACR in the last 13m&nbsp;<\/td><td>Consider contacting these patients to invite them to submit urine sample&nbsp;<\/td><\/tr><tr><td>? DM 3.202 Nephropathy &#8211; Annual review without ACR&nbsp;<\/td><td>Patients whose diabetes annual review took place at least a month ago who haven&#8217;t yet submitted an ACR&nbsp;<\/td><td>Consider contacting these patients to invite them to submit urine sample.&nbsp; This is a good search to run on a regular (e.g. fortnightly) batch&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p>Patients can be contacted by <strong>phone<\/strong>, <strong>SMS<\/strong> or <strong>email<\/strong>.&nbsp;<\/p>\n\n\n\n<p>Suggested text to use in the Communications Annexe&nbsp;<\/p>\n\n\n\n<p>&lt;forename&gt; &lt;surname&gt;&nbsp;<\/p>\n\n\n\n<p>Please could you drop in an early morning urine sample to the surgery.&nbsp; This is due as part of your regular check up.&nbsp;<\/p>\n\n\n\n<p>Regards&nbsp;<\/p>\n\n\n\n<p><em>Organisation Name inserted here<\/em>&nbsp;<\/p>\n<\/div><\/details><\/div>\n\n\n\n<div style=\"height:10px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-genesis-blocks-gb-accordion gb-block-accordion\"><details><summary class=\"gb-accordion-title\">Albuminuria Coding for Diabetics\u00a0<\/summary><div class=\"gb-accordion-text\">\n<p><strong>Definitions<\/strong>&nbsp;<\/p>\n\n\n\n<p>Microalbuminuria &#8211; ACR persistently &gt;=3 to 30 (at least 2 out of 3 samples over a few months)&nbsp;<\/p>\n\n\n\n<p>Albuminuria\/Proteinuria &#8211; ACR persistently &gt;30&nbsp;(at least 2 out of 3 samples over a few months)&nbsp;<\/p>\n\n\n\n<p><strong>Coding Issue<\/strong>&nbsp;<\/p>\n\n\n\n<p>QoF only &#8216;recognises&#8217; patients with diabetes as having microalbuminuria\/albuminuria if they have one of the Snomed codes from the MAL (micoralbuminuria) or PRT (proteinuria) code clusters.&nbsp; The most appropriate codes from these clusters are shown below.&nbsp; QoF does not &#8216;count&#8217; either ACR numeric results &gt;=3 or CKD codes which confirm microalbuminuria e.g. CKD G3a A2 (although QoF does recommend proteinuria CKD codes such as CKD G3b A3)&nbsp;<\/p>\n\n\n\n<p>These are the recommended codes to use for diabetic patients with persistently abnormal ACR results.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table><tbody><tr><td><strong>Diabetes Type<\/strong>&nbsp;<\/td><td><strong>ACR &gt;3&nbsp;<\/strong><\/td><td><strong>ACR &gt;30&nbsp;<\/strong><\/td><\/tr><tr><td>Type 1&nbsp;<\/td><td>Type 1 diabetes mellitus with persistent microalbuminuria&nbsp;<\/td><td>Type II diabetes mellitus with persistent microalbuminuria&nbsp;<\/td><\/tr><tr><td>Type 2&nbsp;<\/td><td>Type II diabetes mellitus with persistent microalbuminuria&nbsp;<\/td><td>Type II diabetes mellitus with persistent proteinuria&nbsp;<\/td><\/tr><tr><td>Other diabetes&nbsp;<\/td><td>Diabetes mellitus with persistent microalbuminuria&nbsp;<\/td><td>Diabetes mellitus with persistent proteinuria&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p>The earliest code from these clusters will be shown in the renal panel of the<strong> Diabetes CDRC <\/strong>template.\u00a0<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"985\" height=\"135\" src=\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-102.png\" alt=\"o \nRenal Function Coding \nACEi\/A2Ra \n8 Mar 2021 \n8 Mar 2021 \n1 Mar 2021 \n01 Mar 2021 \n10 Jan 2020 \nserum creatinine level [XE2q5) (SNOMEO: 1 umoI\/L \nGFR calculated abbreviated MORO rxaK8y) (SNO \n&gt; go mlJmin\/1 \nurine albumin\/creatinine ratio [XE2n3) (SNOMEDL 3 mg\/mmol \nUrine albumin\/creatinine ratio [XE2n3) (SNOMEO: 1 0234g1 0000001 04) \nType Il diabetes mellitus with persistent microalbuminuria (XalzR) (SN \nDone in last 12m \nA Done in last 12m \nOOF NOT Achieved \nconsider ACEi\/A2RB \" class=\"wp-image-4783\" srcset=\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-102.png 985w, https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-102-300x41.png 300w, https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-102-768x105.png 768w\" sizes=\"(max-width: 985px) 100vw, 985px\" \/><\/figure>\n\n\n\n<p>The following reports will help to identify and manage these patients<\/p>\n\n\n\n<p>These reports can be found in the folder <strong><em>CDRC Quality &gt; Diabetes IGR<\/em><\/strong>&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"750\" height=\"127\" src=\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-101.png\" alt=\"7 0M 3201 Nephropathy - ACR not done in last 13m (unless excepted) \n7 0M 3202 Nephropathy - Annual review without ACR \n0M 321 Ne hro ath -Diabetic with ersistent albuminuria Out no aoF albuminuria code \n7 0M 3 211 Nephropathy - Diabetic with repeated albuminuria but no OOF albuminuria code on repeat ACEi\/A2R8 \n? DM 3212 Nephropathy - Diabetic With CKD 4.2\/3 but no OOF albuminuria code \n7 0M 322 Nephropathy - Consider repeating ACR test \n7 0M 3 23 Nephropathy - Consider ACEi\/A2R8 for diabetic kidney disease \" class=\"wp-image-4782\" srcset=\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-101.png 750w, https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-101-300x51.png 300w\" sizes=\"(max-width: 750px) 100vw, 750px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Report<\/strong> <strong>Name<\/strong><\/td><td><strong>Returns<\/strong><\/td><td><strong>Actions<\/strong><\/td><\/tr><tr><td>? DM 3.21 Nephropathy &#8211; Diabetic with persistent albuminuria but no QoF albuminuria code&nbsp;<\/td><td>Patients whose last 2 ACR results are &gt;=3 but who do not have a code in the MAL or PRT clusters&nbsp;<\/td><td>Review record and consider adding relevant code from list above&nbsp;<\/td><\/tr><tr><td>? DM 3.211 Nephropathy &#8211; Diabetic with repeated albuminuria but no QoF albuminuria code on repeat ACEi\/A2RB&nbsp;<\/td><td>Patients who are already on an ACEi\/A2RB who appear to have had repeated ACR results &gt;=3&nbsp;<\/td><td>Review record and consider adding relevant code from list above.&nbsp;&nbsp;<strong>NB this report will improve QoF performance.<\/strong>&nbsp;<\/td><\/tr><tr><td>? DM 3.212 Nephropathy &#8211; Diabetic with CKD A2 but no QoF albuminuria code&nbsp;<\/td><td>Patients whose latest CKD code indicates they have significant albuminuria but who don&#8217;t have a code from the MAL cluster&nbsp;<\/td><td>Review record and consider adding relevant code from list above&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n<\/div><\/details><\/div>\n\n\n\n<div style=\"height:10px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-genesis-blocks-gb-accordion gb-block-accordion\"><details><summary class=\"gb-accordion-title\">Albuminuria Detection for Diabetics\u00a0<\/summary><div class=\"gb-accordion-text\">\n<p><strong>Definitions<\/strong>&nbsp;<\/p>\n\n\n\n<p>Microalbuminuria &#8211; ACR persistently &gt;=3 to 30&nbsp;(at least 2 out of 3 samples over a few months).<\/p>\n\n\n\n<p>Albuminuria\/Proteinuria &#8211; ACR persistently &gt;30&nbsp;(at least 2 out of 3 samples over a few months).<\/p>\n\n\n\n<p>Patients with an isolated raised ACR should have a repeat ACR measured to confirm or refute persistent abnormality.<\/p>\n\n\n\n<p>This report will identify patients with diabetes who might have microalbuminuria\/albuminuria who can be offered a repeat test.<\/p>\n\n\n\n<p>This report can be found in the folder <strong><em>CDRC Quality &gt; Diabetes IGR<\/em><\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"721\" height=\"125\" src=\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-103.png\" alt=\"0M 3201 Nephropathy \n7 0M 3202 Nephropathy \ng processes missing (unless excepted) \n- ACR not done in last 13m (unless excepted) \n- Annual review without ACR \n7 0M 321 Nephropathy - Diabetic with persistent albuminuria but no OOF albuminuria code \n7 0M 3 211 Nephropathy - Diabetic with repeated albuminuria but no OOF albuminuna code on repeat ACEi\/A2R8 \n7 0M 3212 Nephropathy - Diabetic with CKD 4.2\/3 Out no OOF albuminuria code \n0M 322Ne hro ath -Consider re eatin ACR test \n? 0M 323 Nephropathy - Consider ACEi\/A2R8 for diabetic kidney disease \" class=\"wp-image-4784\" srcset=\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-103.png 721w, https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-103-300x52.png 300w\" sizes=\"(max-width: 721px) 100vw, 721px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Report Name<\/strong><\/td><td><strong>Returns<\/strong><\/td><td><strong>Actions<\/strong><\/td><\/tr><tr><td>? DM 3.22 Nephropathy &#8211; Consider repeating ACR test&nbsp;<\/td><td>Patients whose last ACR result (at least two months ago) is &gt;=3 who don&#8217;t have a code in the MAL\/PRT clusters&nbsp;<\/td><td>Review record and consider requesting repeat ACR testing to confirm\/refute albuminuria&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p>Patients can be contacted by <strong>phone<\/strong>, <strong>SMS<\/strong> or <strong>email<\/strong>.&nbsp;<\/p>\n\n\n\n<p>Suggested text to use in the Communications Annexe&nbsp;<\/p>\n\n\n\n<p>&lt;forename&gt; &lt;surname&gt;&nbsp;<\/p>\n\n\n\n<p>Please could you drop in an early morning urine sample to the surgery.&nbsp; This is due as part of your regular check up.&nbsp;<\/p>\n\n\n\n<p>Regards&nbsp;<\/p>\n\n\n\n<p><em>Organisation Name inserted here<\/em>&nbsp;<\/p>\n<\/div><\/details><\/div>\n\n\n\n<div style=\"height:10px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-genesis-blocks-gb-accordion gb-block-accordion\"><details><summary class=\"gb-accordion-title\">ACEi\/A2RB Treatment for DKD\u00a0<\/summary><div class=\"gb-accordion-text\">\n<p>Renin-angiotensin system blockade offers significant benefits to patients with diabetes and persistent ACR&gt;=3.&nbsp; Benefits include reductions in poor renal and cardiovascular outcomes.&nbsp;<\/p>\n\n\n\n<p>One of the diabetes QoF indicators is based on RAS blockade for patients with diabetes and albuminuria.&nbsp;<\/p>\n\n\n\n<p>This report will identify patients with diabetes who have coded albuminuria and who are not taking an ACEi\/A2RB or don&#8217;t have a good reason why not.&nbsp; See Albuminuria Coding for Diabetics for coding issues (above).&nbsp;<\/p>\n\n\n\n<p>This report can be found in the folder <strong><em>CDRC Quality &gt; Diabetes IGR<\/em><\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"737\" height=\"132\" src=\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-106.png\" alt=\"7 0M 3201 Nephropathy - ACR not done in last 13m (unless excepted) \n7 0M 3 202 Nephropathy - Annual review without ACR \n7 0M 321 Nephropathy - Diabetic with persistent albuminuria but no OOF albuminuria code \n7 0M 3 211 Nephropathy - Diabetic with repeated albuminuria Out no OOF albuminuria code on repeat ACEi\/A2R8 \n7 0M 3 212 Nephropathy - Diabetic with CKD 4.2\/3 Out no OOF albuminuria code \n7 0M 322 Nephropathy - Consider repeating ACR test \n0M 323 Ne hro ath -Consider ACEi\/A2R8for diabetic kidne disease \" class=\"wp-image-4787\" srcset=\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-106.png 737w, https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-106-300x54.png 300w\" sizes=\"(max-width: 737px) 100vw, 737px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Report Name<\/strong><\/td><td><strong>Returns<\/strong><\/td><td><strong>Actions<\/strong><\/td><\/tr><tr><td>? DM 3.22 Nephropathy &#8211; Consider repeating ACR test&nbsp;<\/td><td>Patients whose last ACR result (at least two months ago) is &gt;=3 who don&#8217;t have a code in the MAL\/PRT clusters&nbsp;<\/td><td>Review record and consider requesting repeat ACR testing to confirm\/refute albuminuria&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p>&#8216;Good reason why not&#8217; is defined as:&nbsp;<\/p>\n\n\n\n<p>Adverse reaction to ACEi (ever)&nbsp; OR ACEi declined\/not indicated\/not tolerated\/contraindicated (last 12m)&nbsp;<\/p>\n\n\n\n<p>AND&nbsp;<\/p>\n\n\n\n<p>Adverse reaction to A2RB (ever)&nbsp; OR A2RB declined\/not indicated\/not tolerated\/contraindicated (last 12m)&nbsp;<\/p>\n\n\n\n<p>A warning about considering the need for ACEiA2RB will be displayed on the <strong>Diabetes CDRC <\/strong>template, along with the current QoF status.\u00a0A link to the ACEi\/A2RB template is available.\u00a0<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"984\" height=\"138\" src=\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-104.png\" alt=\"Machine generated alternative text:\no \nRenal Function Coding \nACEi\/A2Ra \n8 Mar 2021 \n8 Mar 2021 \n1 Mar 2021 \n01 Mar 2021 \n10 Jan 2020 \nserum creatinine level [XE2q5) (SNOMEO: 1 umoI\/L \nGFR calculated abbreviated MORO rxaK8y) (SNO \n&gt; go mLJmin\/1 \nurine albumin\/creatinine ratio [XE2n3) (SNOMEDL 3 mg\/mmol \nUrine albumin\/creatinine ratio [XE2n3) (SNOMEO: 1 0234g1 0000001 04) \nType Il diabetes mellitus with persistent microalbuminuria (XalzR) (SN \nDone in last 12m \nA Done in last 12m \nOOF NOT Achieved \nconsider ACEi\/A2RB \" class=\"wp-image-4785\" srcset=\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-104.png 984w, https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-104-300x42.png 300w, https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-104-768x108.png 768w\" sizes=\"(max-width: 984px) 100vw, 984px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"982\" height=\"520\" src=\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-105.png\" alt=\"Machine generated alternative text:\nACEijA2RB Exceptions Indications and Dosing Equivalent Doses \nACEi\/A2RB \nCKS - ACEi \nCKS - \nMore detailed information about indications and dosages \nAll ACEi\/A2Ra Issues \nACEi\/A2R8 Exceptions \nC) Angiotensin system drug target dose achieved \nC) Angiotensin system drug target dose not achieved \nMore detailed information about targets \nACEi\/A2Ra Checklist \nACEi\/A2RBs not on repeat \nACEi\/A2RB Possible Indication - Hypertension \nACEi\/A2RB Usually Recommended - Diabetes and micro\/albuminuria \nACEi\/A2RB Usually Recommended - Diabetes and CHD \nMar 2011 \nNotes \nNAngiotensin-conven-enz inhib caus advers efftherap use (IJ60C4) (SNOMED: 2g3500 \ncough with enalapril \nDCS ACEi\/A2RB Target view has no data for patient \nSerum sodium level \nSerum potassium level \nSerum creatinine level \nGFR calculated abbreviated MORO \nDCS ACEi\/A2RB Checklist view has no data for patient \n138 mmol\/L \n44 mmol\/L \n47 umol\/L \n&gt; go mumin\/l \n73m*2 \n08 Mar 2021 \n08 Mar 2021 \n08 Mar 2021 \n08 Mar 2021 \" class=\"wp-image-4786\" srcset=\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-105.png 982w, https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-105-300x159.png 300w, https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2022\/10\/image-105-768x407.png 768w\" sizes=\"(max-width: 982px) 100vw, 982px\" \/><\/figure>\n<\/div><\/details><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Diabetic kidney disease (DKD) is usually a clinical diagnosis in a patient with long-standing diabetes (&gt;10 years) with albuminuria and\/or reduced estimated glomerular filtration rate (eGFR) in the absence of signs or symptoms of other primary causes of kidney damage.&nbsp; Prevention of development\/progression of DKD is helped by &#8216;standard&#8217; interventions that also prevent macrovascular disease [&hellip;]<\/p>\n","protected":false},"author":9,"featured_media":0,"parent":4753,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>SystmOne Diabetic Kidney Disease - Clinical Digital Resource Collaborative<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"SystmOne Diabetic Kidney Disease - Clinical Digital Resource Collaborative\" \/>\n<meta property=\"og:description\" content=\"Diabetic kidney disease (DKD) is usually a clinical diagnosis in a patient with long-standing diabetes (&gt;10 years) with albuminuria and\/or reduced estimated glomerular filtration rate (eGFR) in the absence of signs or symptoms of other primary causes of kidney damage.&nbsp; Prevention of development\/progression of DKD is helped by &#8216;standard&#8217; interventions that also prevent macrovascular disease [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/\" \/>\n<meta property=\"og:site_name\" content=\"Clinical Digital Resource Collaborative\" \/>\n<meta property=\"article:modified_time\" content=\"2023-11-28T10:59:33+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2023\/05\/image-3.png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Estimated reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/\",\"url\":\"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/\",\"name\":\"SystmOne Diabetic Kidney Disease - Clinical Digital Resource Collaborative\",\"isPartOf\":{\"@id\":\"https:\/\/cdrc.nhs.uk\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2023\/05\/image-3.png\",\"datePublished\":\"2023-05-11T09:23:04+00:00\",\"dateModified\":\"2023-11-28T10:59:33+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/#breadcrumb\"},\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-GB\",\"@id\":\"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/#primaryimage\",\"url\":\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2023\/05\/image-3.png\",\"contentUrl\":\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2023\/05\/image-3.png\",\"width\":1493,\"height\":416},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cdrc.nhs.uk\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Resources\",\"item\":\"https:\/\/cdrc.nhs.uk\/resources\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"SystmOne Resource Centre\",\"item\":\"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"SystmOne Specialties\",\"item\":\"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/\"},{\"@type\":\"ListItem\",\"position\":5,\"name\":\"SystmOne Diabetes Overview\",\"item\":\"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/\"},{\"@type\":\"ListItem\",\"position\":6,\"name\":\"SystmOne Diabetic Kidney Disease\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cdrc.nhs.uk\/#website\",\"url\":\"https:\/\/cdrc.nhs.uk\/\",\"name\":\"Clinical Digital Resource Collaborative\",\"description\":\"Designed and developed in the North East and North Cumbria by local GPs\",\"publisher\":{\"@id\":\"https:\/\/cdrc.nhs.uk\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/cdrc.nhs.uk\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-GB\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/cdrc.nhs.uk\/#organization\",\"name\":\"Clinical Digital Resource Collaborative\",\"url\":\"https:\/\/cdrc.nhs.uk\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-GB\",\"@id\":\"https:\/\/cdrc.nhs.uk\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2020\/05\/CDRC-Logo-1.png\",\"contentUrl\":\"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2020\/05\/CDRC-Logo-1.png\",\"width\":777,\"height\":104,\"caption\":\"Clinical Digital Resource Collaborative\"},\"image\":{\"@id\":\"https:\/\/cdrc.nhs.uk\/#\/schema\/logo\/image\/\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"SystmOne Diabetic Kidney Disease - Clinical Digital Resource Collaborative","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/","og_locale":"en_GB","og_type":"article","og_title":"SystmOne Diabetic Kidney Disease - Clinical Digital Resource Collaborative","og_description":"Diabetic kidney disease (DKD) is usually a clinical diagnosis in a patient with long-standing diabetes (&gt;10 years) with albuminuria and\/or reduced estimated glomerular filtration rate (eGFR) in the absence of signs or symptoms of other primary causes of kidney damage.&nbsp; Prevention of development\/progression of DKD is helped by &#8216;standard&#8217; interventions that also prevent macrovascular disease [&hellip;]","og_url":"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/","og_site_name":"Clinical Digital Resource Collaborative","article_modified_time":"2023-11-28T10:59:33+00:00","og_image":[{"url":"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2023\/05\/image-3.png"}],"twitter_card":"summary_large_image","twitter_misc":{"Estimated reading time":"7 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/","url":"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/","name":"SystmOne Diabetic Kidney Disease - Clinical Digital Resource Collaborative","isPartOf":{"@id":"https:\/\/cdrc.nhs.uk\/#website"},"primaryImageOfPage":{"@id":"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/#primaryimage"},"image":{"@id":"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/#primaryimage"},"thumbnailUrl":"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2023\/05\/image-3.png","datePublished":"2023-05-11T09:23:04+00:00","dateModified":"2023-11-28T10:59:33+00:00","breadcrumb":{"@id":"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/#breadcrumb"},"inLanguage":"en-GB","potentialAction":[{"@type":"ReadAction","target":["https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/"]}]},{"@type":"ImageObject","inLanguage":"en-GB","@id":"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/#primaryimage","url":"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2023\/05\/image-3.png","contentUrl":"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2023\/05\/image-3.png","width":1493,"height":416},{"@type":"BreadcrumbList","@id":"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/systmone-diabetic-kidney-disease\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/cdrc.nhs.uk\/"},{"@type":"ListItem","position":2,"name":"Resources","item":"https:\/\/cdrc.nhs.uk\/resources\/"},{"@type":"ListItem","position":3,"name":"SystmOne Resource Centre","item":"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/"},{"@type":"ListItem","position":4,"name":"SystmOne Specialties","item":"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/"},{"@type":"ListItem","position":5,"name":"SystmOne Diabetes Overview","item":"https:\/\/cdrc.nhs.uk\/resources\/systmone-resource-centre\/specialties\/systmone-diabetes-overview\/"},{"@type":"ListItem","position":6,"name":"SystmOne Diabetic Kidney Disease"}]},{"@type":"WebSite","@id":"https:\/\/cdrc.nhs.uk\/#website","url":"https:\/\/cdrc.nhs.uk\/","name":"Clinical Digital Resource Collaborative","description":"Designed and developed in the North East and North Cumbria by local GPs","publisher":{"@id":"https:\/\/cdrc.nhs.uk\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/cdrc.nhs.uk\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-GB"},{"@type":"Organization","@id":"https:\/\/cdrc.nhs.uk\/#organization","name":"Clinical Digital Resource Collaborative","url":"https:\/\/cdrc.nhs.uk\/","logo":{"@type":"ImageObject","inLanguage":"en-GB","@id":"https:\/\/cdrc.nhs.uk\/#\/schema\/logo\/image\/","url":"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2020\/05\/CDRC-Logo-1.png","contentUrl":"https:\/\/cdrc.nhs.uk\/wp-content\/uploads\/2020\/05\/CDRC-Logo-1.png","width":777,"height":104,"caption":"Clinical Digital Resource Collaborative"},"image":{"@id":"https:\/\/cdrc.nhs.uk\/#\/schema\/logo\/image\/"}}]}},"featured_image_src":null,"featured_image_src_square":null,"_links":{"self":[{"href":"https:\/\/cdrc.nhs.uk\/wp-json\/wp\/v2\/pages\/4780"}],"collection":[{"href":"https:\/\/cdrc.nhs.uk\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cdrc.nhs.uk\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cdrc.nhs.uk\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/cdrc.nhs.uk\/wp-json\/wp\/v2\/comments?post=4780"}],"version-history":[{"count":0,"href":"https:\/\/cdrc.nhs.uk\/wp-json\/wp\/v2\/pages\/4780\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/cdrc.nhs.uk\/wp-json\/wp\/v2\/pages\/4753"}],"wp:attachment":[{"href":"https:\/\/cdrc.nhs.uk\/wp-json\/wp\/v2\/media?parent=4780"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}