National Institute for Health and Clinical Excellence (NICE)
NICE publishes rapid COVID-19 guidelines on chronic kidney disease and interstitial lung disease
NICE recently (15 May) published 2 new rapid COVID-19 guidelines. The first is on chronic kidney disease (CKD) and the second on interstitial lung disease.
The guidelines aim to help healthcare professionals determine what care should be provided for people without COVID-19 infection or with confirmed or suspected COVID-19 infection safely and enable services to make the best use of NHS resources.
The guideline on CKD recommends that patients, including those who have symptoms of COVID-19, should be advised to continue taking their medicines (including ACE inhibitors, angiotensin receptor blockers, immunosuppressants and diuretics) as normal unless advised to stop by their healthcare professional.
For patients who are stable on treatment, the guideline recommends they should be assessed to see whether it is safe to reduce the frequency of routine kidney function tests, taking into account any comorbidities and whether their CKD is progressive.
It also says patients who are able to should be encouraged to self-monitor and self-manage (including blood pressure monitoring). Patients who do this should be given access to their medical data (including diagnosis, comorbidities, test results, treatments and correspondence) through information systems such as PatientView, as well as information about when they should seek help and who to contact.
The guideline also advises that patients should continue to be referred
for outpatient appointments if the clinical need is urgent. Patients should also be referred for ultrasound if the result might immediately change their management for example if they have accelerated progression of CKD, or symptoms of urinary tract obstruction.
The guideline on interstitial lung disease provides clinicians with advice on how to adjust care to reduce patients’ exposure to COVID-19 and how to balance the risks and benefits of taking drugs that affect the immune response during the pandemic.
It recommends that, for people newly referred to specialist services, wherever possible existing pulmonary function tests, blood tests and CT scan results should be used to guide diagnosis and treatment. If these results are not available but are needed to guide urgent care, patients should be referred for the relevant tests.
The guideline also highlights that, because bronchoscopy and pulmonary function tests have the potential to spread COVID-19, they should only be carried out if the patient urgently needs them and if the results will have a direct impact on their care.
When considering whether to start or continue treatment with an immunosuppressant, the guideline recommends that the risks and benefits should be discussed with the patient and involve all relevant members of the hospital specialist team. Factors such as whether the required monitoring and review are feasible, if it would be safer to delay starting the drug, and if there are any changes to the dose or route of administration that could make hospital attendance less likely, should all be considered.
Patients already taking antifibrotic drugs should be advised to continue their treatment because there is no evidence they increase the risk of getting COVID-19 or predispose patients to more severe disease.
NICE is collaborating internationally to make the guidelines available so that health systems around the world can see the approach the UK is taking.
The guidelines are being produced in collaboration with NHS England/Improvement and a cross-specialty clinical group, supported by the specialist societies and Royal Colleges.
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