We suggest that the individual’s wishes and comorbidities when considering referral, be taken into account (2D). *It is important to note that intra-individual variation in eGFR readings can be as high as 15–20% between consecutive eGFR measurements, such that a number of readings are required before one can be confident that a decrease in eGFR of >5 ml/min per 1.73 m2 in 6 months is real. Chronic kidney disease is associated with considerable morbidity and increased mortality risk. Biochemical evidence of CKD (reduced estimated GFR, elevated serum creatinine) usually indicates the presence of tubulointerstitial fibrosis within BGJ398 the kidney. Such pathology is irreversible, therefore the aim of

treatment in many patients with CKD is to delay progression of disease rather than achieve a cure. In light of this it is clear that implementation of primary prevention measures to avoid development of CKD is a preferable strategy. While much information is available about risk factors for development of CKD (refer to Early CKD CARI Guideline Part I) it is less clear whether risk factor modification

prevents development of CKD. In addition to primary prevention strategies, the needs of patients and their families to access MAPK Inhibitor Library purchase CKD education and information tailored to the stage and cause of CKD, has been highlighted by some studies. White et al.[25] conducted a cross sectional survey of participants of the AusDiab study to assess the level of awareness of the causes of kidney disease. The results indicated an overall low level of awareness of risk factors for kidney Alectinib concentration disease and low level of recall of kidney function testing even among subgroups of the

cohort who were at greatest risk of CKD.[25] A study by Ormandy et al.[26] found that CKD patients had clear information needs, which changed according to their CKD stage. Moreover, Nunes et al.[27] reported disparity between perceived knowledge and objective knowledge in patients with CKD. Although information is crucial to knowledgeable decision-making by patients, how it is provided is also very important. Successful contemporary educational interventions for people with a chronic disease typically incorporate psychological methods to empower patients and change behaviour.[28] The aim of this guideline was to evaluate currently available clinical evidence of interventions relevant to lifestyle modification, patient education, elevated blood pressure, diabetes mellitus, referral to multidisciplinary care and the effect of pregnancy in the primary prevention of CKD. In this guideline prevention of CKD is defined as a normal serum creatinine, eGFR above 60 mL/min and absence of urinary albumin, protein or haematuria. a. We suggest the maintenance of a stable (within 5%), healthy weight as it is associated with a lower risk of developing CKD (2C) c.