What is Chronic Kidney Disease?
Chronic kidney disease (CKD) is:
- The persistent and usually progressive reduction in glomerular filtration
rate (GFR less than 60 mL/min/1.73 m2), and/or
- Albuminuria (more than 30mg of urinary albumin per gram of urinary creatinine)
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Who is at Risk For Chronic Kidney Disease?
Diabetes and high blood pressure are the leading causes of kidney failure.
Individuals with a family history of kidney failure are also at risk.
Chronic kidney disease may also result from:
- Hereditary factors, such as polycystic kidney disease (PKD)
- A direct and forceful blow to the kidneys
- Prolonged consumption of some over-the-counter painkillers that combine aspirin,
acetaminophen, and other medicines such as ibuprofen
The risk of kidney failure is not uniform
Relative risks compared to Whites:
- African Americans 3.8 X
- Native Americans 2.0 X
- Asians 1.3 X
Available data also suggests that Hispanics have an increased risk as well.
Cardiovascular disease is linked to CKD
- Annual mortality from CVD is increased 10 - 100 times with kidney failure
- Risk of CVD is increased 1.4 - 2.05 times with creatinine >1.4 - 1.5 mg/dl
Risk of CVD is increased 1.5 - 3.5 times with microalbuminuria.
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How Do I Test My Patients for Chronic Kidney Disease?
Use these tests to detect chronic kidney disease
In individuals with diabetes:
- "Spot" urine albumin to creatinine ratio
In others at risk:
- Estimate GFR from serum creatinine using the MDRD
- "Spot" urine albumin to creatinine ratio or standard dipstick Estimate GFR
from serum creatinine using the MDRD prediction equation
NOTE: 24 hour urine collections are NOT needed
Simple testing is needed to detect early chronic kidney disease. Test patients
- Diabetes once per year.
- Hypertension at diagnosis and initiation of therapy-then, if normal,
every 3 years.*
- A family history of kidney failure every 3 years as long as the tests
- Others at risk less frequently as long as normal.
*This testing interval is opinion based. Use your discretion.
Chronic kidney disease is not being recognized or treated
- Most practices screen fewer than 20% of their Medicare patients with diabetes.
- Patients are referred late to a nephrologist, especially African-American
- Less than 1/3 of people with identified CKD get an angiotensin converting
enzyme (ACE) Inhibitor.
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How Can I Help My Patients Slow Chronic Kidney Disease and Prevent Kidney
Prevention is possible. Early treatment can slow progression and reduce cardiovascular
For patients with diabetes or hypertension and chronic kidney disease
- Prescribe ACE inhibitor or angiotensin receptor blocker to protect kidney
- A diuretic should usually be part of the hypertension regimen.
- Keep blood pressure below 130/80 mmHg.
- Advise tight glycemic control for patients with diabetes.
- Provide referral for dietary counseling (Medicare will pay for nutrition counseling
For patients with a family history of chronic kidney disease
- Advise patients to take action to prevent hypertension and diabetes.
It is also important to:
- Monitor and treat traditional cardiovascular risk factors, particularly smoking
- Refer patients to a nephrologist for an early opinion.
- Team with a nephrologist once the GFR is 30 mL/min/1.73 m2 or less.
- Provide on-going primary care.
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Who Should Be Treated and What Are The Best Treatments?
Patients who should be treated for chronic kidney disease
- With urine albumin/creatinine ratios more than 30mg albumin/1 gram creatinine
- With urine albumin/creatinine ratios more than 300mg albumin/1 gram creatinine
corresponding to about 1+ on standard dipstick
- With estimated GFR less than 60 mL/min/1.73 m2
Treatment for chronic kidney disease
- Maintain blood pressure less than 130/80 mmHg.
- Use an ACE Inhibitor or ARB.
- More than one drug is usually required and diuretic should be part of the
- Refer patient to a dietitian.
- Continue best possible glycemic control in individuals with diabetes.
- Consult a nephrologist early.
- Team with them for care if GFR is less than 30 mL/min/1.73 m2.
- Monitor hemoglobin and phosphorous with treatment as needed.
- Treat cardiovascular risk, especially smoking and hypercholesterolemia.
Early Treatment Makes A Difference
What Can Primary Care Providers Do?
- Recognize who is at risk.
- Provide testing and treatment.
- Encourage labs to provide and report estimated GFR and spot urine albumin/creatinine
- Encourage labs to use and report estimated GFR and spot quantification of
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What information Can I Provide To My Patients?
NKDEP provides free educational materials
for patients and their families.
Where Can I Find More Information About Chronic Kidney Disease?
NKDEP provides free resources
for health professionals.
National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)
3 Information Way
Bethesda, MD 20892