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A Practical Approach to Detection and Management of Chronic Kidney Disease for the Primary Care Clinician.
Am J Med. 2015 Sep 18;
Authors: Vassalotti JA, Centor R, Turner BJ, Greer RC, Choi M, Sequist TD, U.S. Kidney Disease Outcomes Quality Initiative
Abstract
A panel of internists and nephrologists developed this practical approach for the Kidney Disease Outcomes Quality Initiative (KDOQI) to guide assessment and care of chronic kidney disease by primary care clinicians. Chronic kidney disease is defined as a glomerular filtration rate (GFR) < 60 ml/min/1.73m(2) and/or markers of kidney damage for at least three months. In clinical practice, the most common tests for chronic kidney disease include glomerular filtration rate estimated from the serum creatinine concentration (eGFR) and albuminuria from the urinary albumin-creatinine ratio (ACR). Assessment of estimated glomerular filtration rate and albuminuria should be performed for persons with diabetes and/or hypertension but is not recommended for the general population. Management of chronic kidney disease includes reducing the patient's risk of chronic kidney disease progression and risk of associated complications such as acute kidney injury and cardiovascular disease, anemia, metabolic acidosis, as well as mineral and bone disorder. Prevention of chronic kidney disease progression requires blood pressure < 140/90 mm Hg, use of ACE inhibitors (ACE-1) or angiotensin receptor blockers (ARB) for patients with albuminuria and hypertension, hemoglobin A1c< 7% for patients with diabetes, and correction of chronic kidney disease-associated metabolic acidosis. To reduce patient safety hazards from medications, the level of estimated glomerular filtration rate should be considered when prescribing and nephrotoxins should be avoided such as nonsteroidal anti-inflammatory drugs (NSAIDs). The main reasons to refer to nephrology specialists are estimated glomerular filtration rate < 30 ml/min/1.73m(2), severe albuminuria, and acute kidney injury. The ultimate goal of chronic kidney disease management is to prevent disease progression, minimize complications, and promote quality of life.
PMID: 26391748 [PubMed - as supplied by publisher]