New COVID-19 guidelines for CKD and interstitial lung disease

The National Institute for Health and Care Excellence has published two new rapid COVID-19 guidelines for chronic kidney disease (CKD) and interstitial lung disease.

The group said the guidelines aim to help healthcare professionals decide what care should be provided for people without COVID-19 infection or with confirmed or suspected infection safely while making 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 as normal unless advised to stop by their healthcare professional.

Those who are stable on treatment should be assessed to determine whether it is safe to reduce the frequency of routine kidney function tests, 'taking into account any comorbidities and whether their CKD is progressive'.

Patients who are able to should self-monitor and self-manage at home, and should be given access to their medical data through information systems such as PatientView as well as information on when to seek help and who to contact.

According to the recommendations, patients should continue to be referred for outpatient appointments 'if the clinical need is urgent'.

The guideline on interstitial lung disease provides advice on how care settings can be adjusted to reduce patients’ exposure to COVID-19 as well as balancing the risks and benefits of taking drugs that affect the immune response during the pandemic.

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', though if these are not available then patients should referred for tests when necessary.

However, as bronchoscopy and pulmonary function tests could potentially 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 treatment with an immunosuppressant, risks and benefits should be discussed with the patient, and factors such as whether 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 be taken into account, the Institute noted.

Patients already taking antifibrotics should continue treatment as there is no evidence these increase the risk of getting COVID-19 or predispose patients to more severe disease.

NICE noted that it is collaborating internationally to make its guidelines available so that health systems around the world can see the approach the UK is taking.