ACE Clinical Guidances (ACGs)

ACE Clinical Guidances (ACGs)

ACGs* provide concise, evidence-based recommendations to inform specific areas of clinical practice and serve as a common starting point nationally for clinical decision-making. ACGs are underpinned by a wide array of considerations contextualised to Singapore, based on best available evidence at the time of development. Each ACG is developed in collaboration with a multidisciplinary group of local experts representing relevant specialties and practice settings. ACGs are not exhaustive of the subject matter and do not replace clinical judgement. 

Registered doctors, pharmacists and nurses may claim 1 Continuing Medical Education (CME)/Continuing Professional Education (CPE) point under category 3A/ Category V-B for reading each ACG.

*previously known as Appropriate Care Guides
Published on 27 Oct 2023
Last Updated on 27 Oct 2023
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This ACE Clinical Guidance (ACG) highlights the importance of personalised management for patients with early-stage chronic kidney disease (CKD) to delay progression and reduce cardiovascular complications. The ACG offers evidence-based recommendations on optimising blood pressure and albuminuria, with considerations for management in the context of associated comorbid conditions. Principles of tailored lifestyle intervention, regular follow-up, and options for shared or multidisciplinary care are also discussed.

Download the PDF below to access the ACG.
Registered doctors, pharmacists and nurses may claim 1 Continuing Medical Education (CME)/Continuing Professional Education (CPE) point under category 3A/ category V-B for reading each ACG.

 

ACG Recommendations
1.Personalise the management plan based on CKD stage, including underlying cause.
2.Optimise blood pressure control and albuminuria management with an ACE inhibitor or ARB, and titrate to maximum tolerated dose as needed.
3.Add an SGLT2 inhibitor to ACE inhibitor/ARB therapy for patients with CKD and persistent albuminuria, regardless of DM status.
4.Optimise management of CKD-related comorbidities.
5.Encourage and provide education on lifestyle intervention through shared decision-making.
6.Regularly follow up all patients with CKD, with more frequent review for those at increased risk of disease progression.
7.Consider shared or multidisciplinary care depending on CKD progression and other clinical needs.
CKD – delaying progression and reducing cardiovascular complications (Oct 2023) CKD – delaying progression and reducing cardiovascular complications references (Oct 2023)

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