CKD – Camden Integrated Care Service (CICS)

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The integrated chronic kidney disease (CKD) service is a consultant-led triage service and specialist nurse-led community CKD clinic provided by Royal Free London.

Triage outcomes

All referrals will be triaged/assessed and a response communicated back to the referring GP within two weeks of submission. The four outcomes following triage are:

  • Virtual advice (within two weeks)
  • Patient will be seen in nurse-led community clinic
  • Patient will be referred to diagnostic clinic at Royal Free Hospital
  • Patient is referred to specialist clinic in secondary care

 

Nurse-led community CKD clinic

The community CKD nursing team run nurse-led clinics, providing specialist, high quality, expert nursing care and support for patients and their families with a diagnosis of chronic kidney disease. The lead nurse and clinical nurse specialist within the community CKD team conduct autonomous nurse-led clinics. They carry out a variety of extended or advanced nursing practices in relation to this and work with the support and governance from the lead clinician and the multi-disciplinary team.

 

The aim of the CKD service is to delay the progression of patients’ renal disease by managing risk factors and symptoms of CKD through health related behaviour change, health education and promotion and medicines management.

For patient information leaflets, see Downloads

Useful contacts:

diabetes.ckd@nhs.net
rf.communityckdservice@nhs.net


Eligibility criteria

Inclusions

 

  • Camden-registered patients aged >18 who have a renal disorder including but not limited to:
    • proteinuria consistency of >1g /24 hours or UPCR of >100
    • haematuria in the under-50s
    • progressive CKD with a fall in GFR >5 ml/min/annum
  • If a GP has concerns regarding aspects of managing a patient with CKD, please refer to the service. When completing the CKD template explain the reason for referral explicitly in the appropriate free-text box.
  • All referrals sent to the integrated CKD service will be triaged.

 

 

See the inclusion/exculsion referral criteria and required pre-referral test results.

Exclusions

 

  • paediatric patients
  • urgent referrals:
    • acute kidney injury (acute renal failure)
    • malignant hypertension
    • hyperkalaemia (K+ >7mmol/L)
    • nephrotic syndrome

 

 


How to refer

The following clinicians can refer to this service: GPs

EMIS form Download Form

Referral methods: e-Referrals

Please complete EMIS form and send via e-Referrals through CHI RSS

  1. Priority: Routine
  2. Specialty: General Medicine
  3. Clinic Type: General Medicine 
  4. Submit for triage: Camden Integrated Care Service (CICS) – Diabetes & CKD