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

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

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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Included if they also have a Proteinuria code

R110. [D]Proteinuria
R1100 [D]Albuminuria
R1103 [D]Microalbuminuria
R110z [D]Proteinuria NOS
1Z1B. Chronic kidney disease stage 3 with proteinuria
1Z1D. Chronic kidney disease stage 3A with proteinuria
1Z1F. Chronic kidney disease stage 3B with proteinuria
1Z1H. Chronic kidney disease stage 4 with proteinuria
1Z1K. Chronic kidney disease stage 5 with proteinuria

And a Hypertension code

G2. Hypertensive disease
G20.. Essential hypertension
G200. Malignant essential hypertension
G201. Benign essential hypertension
G202. Systolic hypertension
G203. Diastolic hypertension
G20z. Essential hypertension NOS
G24.. Secondary hypertension - G2z Hypertensive disease NOS
Excluding:
(Excluding G24z1, G2400, G2410, G27.. Hypertension resistant to drug therapy (v24) )

Gyu2. [X]Hypertensive diseases
Gyu20 [X]Other secondary hypertension
Gyu21 [X]Hypertension secondary to other renal disorders (Removed in v23)

Without Hypertension resolved (after diagnosis date)

21261 Hypertension resolved
212K. Hypertension resolved
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Ace inhibitor contraindications; persistent

14LM. H/O: angiotensin converting enzyme inhibitor allergy
U60C4 [X]Angiotensin-converting-enzyme inhibitors causing adverse effects in therapeutic use
ZV14D [V]Personal history of angiotensin-converting-enzyme inhibitor allergy
TJC77 Adverse reaction to captopril
TJC78 Adverse reaction to enalapril
TJC79 Adverse reaction to ramipril

K0430 Acute renal failure due to ACE inhibitor(v26)

Ace inhibitor contraindications; expiring (12 months)

8I28. Angiotensin converting enzyme inhibitors contraindicated
8I3D. Angiotensin converting enzyme inhibitor declined
8I64. Angiotensin converting enzyme inhibitor not indicated
8I74. Angiotensin converting enzyme inhibitor not tolerated

AII antagonist contraindications: persisting

14LN. H/O: angiotensin II receptor antagonist allergy
U60CB [X]Angiotensin II receptor antagonists causing adverse effects in therapeutic use
ZV14E [V]Personal history of angiotensin II receptor antagonist allergy

AII antagonist contraindications: expiring (12 months)

8I2H. Angiotensin II receptor antagonists contraindicated
8I3P. Angiotensin II receptor antagonist declined
8I6C. Angiotensin II receptor antagonist not indicated
8I75. Angiotensin II receptor antagonist not tolerated

Ace inhibitor prescription codes (prescribed in the last 6 months)

bi...%
bA…%
bk6..%

AII antagonist prescription codes (prescribed in the last 6 months)

bk3.. - bk5z.
bk7.. - bk9z.
bkB..% OLMESARTAN
bkC..% HYDROCHLOROTHIAZIDE + OLMESARTAN
bkD..% AMLODIPINE + VALSARTAN

bkI..%
bkH..%
bkJ..%

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Chronic Kidney Disease 003.1 Rationale

ACE inhibitors and ARBs are generally more effective than other anti-hypertensives in minimising deterioration in kidney function and this effect is most marked where there is significant proteinuria. Such treatment is both clinically and cost-effective (Kent et al JASN 2007; 18; 1959-1965)

See also: Lewis et al. NEJM 1993; 329:1456-1462; Brenner et al. NEJM 2001; 345:861-869; Ruggenenti et al. Lancet 1999; 354: 359-364).

The gold standard test for measuring proteinuria is a 24-hour urine collection; though problems with timing and completeness make this an impractical test to use in general practice. The alternatives are to test the albumin-creatinine ratio (ACR) or protein-creatinine ratio (PCR) in the urine or to use a stick test.

The SIGN clinical guidlines for CKD also recommends measuring proteinuria with ACR in patients with diabetes and TPCR in non-diabetic patients, reflecting the differing evidence base for theses two patient populations whereas recent NICE guidance has suggested that the ACR should be used in all patients.

Further /information:
www.nice.org.uk/Guidance/CG73
www.sign.ac.uk/guidelines/fulltext/103/index.html

Therefore patients who wko are non-diabetic stage 3 to 5 CKD should have an annual test of proteinuria unless they have a previous diagnosis of proteinuria. ideally using ACR, or PCR according to local guidance. People with diabetes already have an annual micro-albuminuria test.

A systematic review has shown that investigation for infection of asymptomatic people with one “+” or more of proteinuria is not indicated (Carter JL et al Nephrol Dial Transplant. 2006 Nov; 21(11):3031-7). Practitioners should only go on to send off a mid-stream urine or perform another test to look for infection if there are symptoms.

It is not possible to derive a simple correction factor that allows the conversion of ACR values to PCR or 24 hour urinary protein excretion rates because the relative amounts of albumin and other proteins will vary depending on the clinical circumstances; however, the following table of approximate equivalents will allow clinicians unfamiliar with ACR values to see the approximate equivalent PCR and 24 hour urinary protein excretion rates (see Table 4).

Table 4: Approximate equivalent ACR, PCR and 24-hour urinary protein excretion

Albumin:creatinine ratio
(mg/mmol)
Protein:creatinine ratio
(mg/mmol)
24 hour urinary protein excretion (g/day)
30
50
0.5
70
100
1

Chronic kidney disease 003.2 Reporting and verification

See indicator wording for requirement criteria.

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Prepared By Jean Keenan