Chronic kidney disease: identification and management in primary care

Abstract

Chronic kidney disease (CKD) is an important and common noncommunicable condition globally. In national and international guidelines, CKD is defined and staged according to measures of kidney function that allow for a degree of risk stratification using commonly available markers. It is often asymptomatic in its early stages, and early detection is important to reduce future risk. The risk of cardiovascular outcomes is greater than the risk of progression to end-stage kidney disease for most people with CKD. CKD also predisposes to acute kidney injury – a major cause of morbidity and mortality worldwide. Although only a small proportion of people with CKD progress to end-stage kidney disease, renal replacement therapy (dialysis or transplantation) represents major costs for health care systems and burden for patients. Efforts in primary care to reduce the risks of cardiovascular disease, acute kidney injury, and progression are therefore required. Monitoring renal function is an important task, and primary care clinicians are well placed to oversee this aspect of care along with the management of modifiable risk factors, particularly blood pressure and proteinuria. Good primary care judgment is also essential in making decisions about referral for specialist nephrology opinion. As CKD commonly occurs alongside other conditions, consideration of comorbidities and patient wishes is important, and primary care clinicians have a key role in coordinating care while adopting a holistic, patient-centered approach and providing continuity. This review aims to summarize the vital role that primary care plays in predialysis CKD care and to outline the main considerations in its identification, monitoring, and clinical management in this context.

Association of single nucleotide polymorphism (rs741301) of the ELMO1 gene with diabetic kidney disease in Polish patients with type 2 diabetes: a pilot study

“…Haemoglobin A 1c was measured using high-performance liquid chromatography (HPLC), and the outcome was expressed in National Glycohemoglobin Standardisation Program/Diabetes Control and Complication Trial units [32]. Serum creatinine was determined with Jaffe's method and estimated glomelural filtration rate (eGFR) per 1.73 m 2 and was calculated according to the CKD-EPI formula [33]; these results were classified into five stages of the disease (G1-G5) [34]. The UACR was estimated using immunoturbidimetric methods and was drawn from the patients' medical history (we analysed three morning urine samples collected over six months).…”

The impact of chronic kidney disease on developed countries from a health economics perspective: A systematic scoping review

“…The problem was ranked 16 th among the leading causes of death in 2016, and is expected to rise to 5 th ranked by 2040 [2]. Chronic kidney disease is defined as an abnormality of kidney function or structure for � 3 months [3] and is a significant burden for individuals, health care systems and societies; it is associated with increased hospitalization, productivity loss, morbidity and early mortality. Diabetic kidney disease is the leading cause of CKD [4]; other common causes include hypertension, glomerulonephritis and autosomal dominant polycystic kidney disease [5].…”

“…Chronic kidney disease is classified based on abnormal urinalysis and/or renal tract structure and estimated glomerular filtration rate (eGFR), with the most advanced stage, CKD stage 5, comprising individuals with an eGFR <15 ml/min/1.73m 2 including patients with endstage renal disease (ESRD) [1]. Chronic kidney disease is managed through treatment of its risk factors, such as hypertension and diabetes mellitus [3]. A small proportion of patients with CKD progress to ESRD requiring renal replacement therapy (RRT) with dialysis and/or kidney transplantation (KTx) [6].…”

Amikor a neuropathia tünetei megelőzik a diabetes diagnózisát – neuropathiaszűrés fontossága a háziorvosi praxisban – esetismertetés

“…Az albuminuria megjelenése jelentősen fokozza a veseelégtelenség és a cardiovascularis betegség, valamint a halálozás kockázatát. 19 Betegünk esetében a 2-es típusú diabetes diagnózisát követően elvégzett vizsgálatok során az eGFR 60 ml/min./1,73 m 2 -nak bizonyult, albuminuria és retinopathia diabetica nem volt kimutatható. Ez a körülmény azt valószínűsíti, hogy a vesefunkció későbbi beszűkülése vélhetően nem lehetett önmagában nephropathia diabetica következménye, hanem abban valószínűsíthetően a nephropathia számos egyéb, a beteg esetében kétségtelenül fennálló rizikótényezője (férfi nem, 70 év feletti életkor, hypertoniabetegség, atherogen dyslipidaemia) is fontos szerepet játszhatott.…”