Chronic Kidney Disease (CKD)
Provenance Certificate
Overview
| Editorial methodology
| References
| Contributors
| Disclaimers
Overview
This document describes the provenance of MidCentral District Health Board’s Chronic Kidney Disease
(CKD) Pathways.
This localised pathway was last updated in August 2015 upon review by a subgroup of the original CKD
Pathway Working Group. The Pathway was updated to align with the MoH Managing Chronic Kidney
Disease in Primary Care National Consensus Statement 2015 and BPAC - the detection and management
of patients with chronic kidney disease in primary care.
One feature of the “Better, Sooner, More Convenient” (BSMC) Business Case, accepted by the Ministry of
Health in 2010, was the development of 33 collaborative clinical pathways (CCP).
The purpose of implementing the CCP Programme in our DHB is to:
 Help meet the Better Sooner More Convenient Business Case aspirational targets, particularly the
following:
o Reduce presentations to the Emergency Department (ED) by 30%
o Reduce avoidable hospital admissions to Medical Wards and Assessment Treatment and
Rehabilitation for over-65-year-olds by 20%
o Reduce poly-pharmacy in the over-65-year-olds by 10%
 Implement a tool to assist in planning and development of health services across the district,
using evidence-based clinical pathways.
 Provide front line clinicians and other key stakeholders with a rapidly accessible check of best
practice;
 Enhance partnership processes between primary and secondary health care services across the
DHB.
Editorial methodology
This care map was based on high-quality information and known Best Practice guidelines from New
Zealand and around the world including Map of medicine editorial methodology. It has been checked by
individuals with front-line clinical experience (see Contributors section of this document).
Map of Medicine pathways are constantly updated in response to new evidence. Continuous evidence
searching means that pathways can be updated rapidly in response to any change in the information
landscape. Indexed and grey literature is monitored for new evidence, and feedback is collected from
users year-round. The information is triaged so that important changes to the information landscape are
incorporated into the pathways through the quarterly publication cycle.
References
This care map has been developed according to the Map of Medicine editorial methodology. The content
of this care map is based on high-quality guidelines and practice-based knowledge provided by
contributors with front-line clinical experience. This localised version of the evidence-based, practiceinformed care map has been peer-reviewed by the CCP Executive Team and with stakeholder groups.
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The Renal Association (RA). The UK eCKD Guide. Hampshire: The Renal Association 2009. Available from:
http://www.renal.org/information-resources/the-uk-eckd-guide#sthash.FrMKGlH1.Uaa3LLyc.dpbs
BPAC – the detection and management of patients with chronic kidney disease in primary care. BPJ Issue 66.
http://www.bpac.org.nz/BPJ/2015/February/ckd.aspx
Contributors representing the Chronic Kidney Disease Collaborative Working Group – MidCentral District
Joint Speciality Committee on Renal Medicine of the Royal College of Physicians of London (RCP) and the
Renal Association (RA). Identification, management and referral of adults with chronic kidney disease.
Guidelines for General Physicians and General Practitioners 5. London: RCP; 2006.
Renal Association (RA). Chronic kidney disease in adults: UK guidelines for identification, management and
referral. London: RA; 2005.
Ministry of Health (MoH). 2015. Managing Chronic Kidney Disease in Primary care: National Consensus
Statement. Wellington. Ministry of Health. Available at: www.health.govt.nz
MidCentral DHB (2012) Primary care management of increased creatinine, management of slowly
progressing renal Impairment Palmerston North: MidCentral DHB.
National Clinical Guideline Centre (NCGC). Chronic kidney disease (partial update): early identification and
management of chronic kidney disease in adults in primary and secondary care: clinical guideline 182.
London: NCGC; 2014. Available from: http://www.nice.org.uk/guidance/cg182/evidence/cg182-chronickidney-disease-update-full-guideline3
Clinical Knowledge Summaries (CKS). Chronic kidney disease - not diabetic. December 2014. Newcastle upon
Tyne: CKS; 2014. Available from: http://cks.nice.org.uk/chronic-kidney-disease-not-diabetic
Scottish Intercollegiate Guidelines Network (SIGN). Diagnosis and management of chronic kidney disease. A
national clinical guideline. SIGN publication no. 103. Edinburgh: SIGN; 2008. Available from:
http://www.sign.ac.uk/pdf/sign103.pdf
Kidney Health New Zealand (2010) Chronic Kidney Disease (CKD) Management in General Practice Summary
Guide.
New Zealand Guidelines Group (2012) New Zealand Primary Care Handbook 2012 Wellington: Ministry of
Health
New Zealand Guidelines Group (NZGG) (2011) Guidance on the Management of Type 2 Diabetes
Kidney Disease Improving Global Outcomes (KDIGO). KDIGO 2012 clinical practice guideline for the
evaluation and management of chronic kidney disease. Kidney Int Suppl 2013; 3: 1-150. Available from:
http://www.guideline.gov/content.aspx?id=46510&search=chronic+kidney+disease
Schroth RJ, Hitchon CA, Uhanova J et al. Hepatitis B vaccination for patients with chronic renal failure.
Cochrane Database Syst Rev 2004; CD003775. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/15266500
Map of Medicine International Contributors representing the Royal College of Physicians; 2009
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MidCentral DHB’s Collaborative Clinical Pathway editors and facilitators worked with clinical
stakeholders such as front-line clinicians and pharmacists to gather practice-based knowledge for its care
maps.
Review sub-group members included:

Dr Norman Panlilio, Nephrologist, MidCentral Health (Secondary Care Clinical Lead)

Gillian Treloar, Nurse Manager, Renal Service, MidCentral Health (Secondary Care Clinical Lead)

Lois Nikolajenko, Clinical Nurse Specialist (CNS), Diabetes and Long Term Conditions (Primary
Care Clinical Lead)

Dr Curtis Walker, Renal and General Physician, MidCentral Health

Dr Stephen Lombard, General Practitioner

Karen Lombard, Community Pharmacy Advisor

Alaina Glue (Facilitator/Editor)
Original Working group members included:

Dr Norman Panlilio, Nephrologist, MidCentral Health (Secondary Care Clinical Lead)

Gillian Treloar, Nurse Manager, Renal Service, MidCentral Health (Secondary Care Clinical Lead)

Lois Nikolajenko, Clinical Nurse Specialist (CNS), Diabetes and Long Term Conditions (Primary
Care Clinical Lead)

Dr Stephen Lombard, General Practitioner

Alison Fellerhoff, CNS, Diabetes, MidCentral Health

Karen Lombard, Community Pharmacy Advisor

Vicki Bryant, Practice Nurse

Dr David Ayling, Primary Health Care Practitioner (Facilitator)

Shirley-Anne Gardiner, Project Director, Health Care development, MidCentral DHB (Pathway
Editor)

Beth McPherson, CNS, Acute Care (Pathway Editor)
This pathway was distributed widely for consultation and comments received have been acknowledged
and taken into consideration in the final document.
Disclaimers
CCP Executive Team, MidCentral DHB
It is not the function of the CCP Executive Team, MidCentral DHB to substitute for the role of the
clinician, but to support the clinician in enabling access to know-how and knowledge. Users of the Map
of Medicine are therefore urged to use their own professional judgement to ensure that the patient
receives the best possible care. Whilst reasonable efforts have been made to ensure the accuracy of the
information on this online clinical knowledge resource, we cannot guarantee its correctness and
completeness. The information on the Map of Medicine is subject to change and we cannot guarantee
that it is up-to-date.