CLINICAL PATHWAY GUIDELINES

CHRONIC KIDNEY DISEASE

Absolute Indications for 1. Uremic encephalopathy

Hemodialysis 2. Fluid and electrolyte abnormalities refractory to other measures
3. Intractable Acidosis
4. Uremic pericarditis
5. Bleeding diathesis
Cockcroft-Gault equation = (140 - age in years) x (wt in kg) / (serum creatinine in mg/dL) x 72 (M) 85(F)

Cockcroft-Gault equation = (140 - age in years) x (wt in kg) / (serum creatinine in mg/dL) x 72 (M) 85(F)

HISTORY AND P.E.

** For CKD patients currently on HD, the number of days admitted in a hospital will equal to the
number of dialysis sessions that is to be deducted in a year. -PHIc.

LABORATORY
1. Complete Blood Count
2. Serum Creatinine
3. Serum Electrolyte

CKD 1-4 CKD 5

On Hemodialysis Not On Hemodialysis

Admit and Manage as
per CPG; by system and
by symptoms (-) Absolute (+) Absolute
indications for HD indications for HD A

Improving Status
Discharge and advise
Follow-up and Nephro
consult
1. Hold Patient for Stabilize Patient;
observation for Maximize mgmt as
2-4 hrs (ER level) per CPG. (ER level) Refer to
2. Maximize mgmt. Patient’s HD Center
Prime for “E” HD
as per CPG

Improving Status Progression of Sx

 A
(+) Absolute (-) Absolute
indications for HD indications for HD

Stabilize Patient; Admit and Maximize

Maximize mgmt as mgmt. as per CPG
per CPG (ER level)
Prime for AVF
Prime for “E” HD creation

Refer Good Response to Unresponsive to

Clinical Mgmt Clinical Mgmt, or
worsening of conditon
Kalinga Resident Cagayan Resident

Discharge and advise

CVMC Follow-up and Nephro Refer
KPH
consult

Kalinga Resident Cagayan Resident

Non-
accommodation

KPH CVMC

Non-
accommodation