Chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function for ≥ 3 months, with implications for health.1
(one or more)
|Albuminuria (UACR ≥ 30mg/g)
Structural abnormalities detected by imaging
Abnormalities detected by histology
History of kidney transplantation
|Decreased GFR||eGFR < 60 ml/min/1.73m2|
UACR: Urinary albumin to creatinine ratio eGFR: estimated glomerular filtration rate
Albumin is the most common protein found in the blood. When the kidneys are damaged, albumin can be excreted into the urine instead of filtering through the kidneys. Albuminuria may be the earliest sign of glomerular disease and is an independent risk factor for CKD progression. It is also a clinical marker for cardiovascular disease (CVD).
About estimated glomerular filtration rate.
eGFR is an estimate of kidney function. It reflects the total filtration by all functioning nephrons. As nephrons are damaged or destroyed, eGFR declines. Decreased eGFR reflects progression of CKD.
What are the symptoms of kidney disease?
Early kidney disease usually does not present with significant signs or symptoms and often goes unrecognized. Check your patients for kidney disease if they have any of these symptoms:
- Frequent urination
- Muscle cramps
- Shortness of breath
- Dry, itchy skin
- Chest pain
What causes CKD?
About 70 percent of new cases of CKD and end-stage renal disease (ESRD) are secondary to other chronic diseases, such as diabetes and hypertension. CKD can also be inherent, like polycystic kidney disease, or occur with unknown etiology. Still other genetic, behavioral, and demographic factors increase the susceptibility and progression of kidney disease. Many risk factors can be managed and controlled to avert the onset of CKD. Patients presenting with risk factors should be evaluated for CKD because it can be treated, managed, and prevented from progressing.
Who is at risk?
|Risk factor: Disease or condition||Modifiable?|
|Diabetes type 1 and 2||Yes|
|Acute kidney injury||Yes|
|Risk factor: Lifestyle/behavior||Modifiable?|
|Poor diet, e.g., high in salt||Yes|
|Overuse of NAISDs||Yes|
|Risk factor: Biomedical markers||Modifiable?|
|Poor glycemic control||Yes|
|Poor blood pressure control||Yes|
|Risk factor: Genetics||Modifiable?|
|Polycystic kidney disease||No|
|Risk factor: Demographics||Modifiable?|
|Age > 60||No|
|Low socioeconomic status||No|
What can primary care physicians (PCP) do to help prevent and manage CKD?
Encourage patients to adopt and maintain healthy behaviors:
- Be physically active.
- Eat a healthy diet low in fat, salt, and sugar.
- Maintain a healthy weight.
- Avoid tobacco products.
- Avoid overuse of ibuprofen and analgesics.
- Hydrate to maintain electrolyte balance.*
- Hydrate during exercise to avoid dehydration.
- Assess all patients for CKD risk factors.
- Treat and manage CKD risk factors.
- Test at-risk patients to detect kidney problems early.
- Treat and manage CKD and comorbid conditions to delay and stop progression.
- Know when to team with a nephrologist.
*Hydration should be individualized to patients to avoid too much liquid in the setting of CKD.
Importance of multidisciplinary care.
Patients with CKD and other chronic diseases benefit from multidisciplinary care. A patient care team may include the PCP, nephrologist, renal dietitian, disease self-management educator, case manager, and other specialists as indicated.
1Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guidelines for the Evaluation and Management of Chronic Kidney Disease. Kidney Inter, Suppl. 2013; 3; 1-150.