Chronic Kidney Disease Diagnosis and Management: A Review

Chronic Kidney Disease Diagnosis and Management: A Review

2019 October 01; 322(13): 1294–1304. | Teresa K. Chen, MD, MHS, Daphne H. Knicely, MD, Morgan E. Grams, MD, PhD
Chronic Kidney Disease (CKD) affects 8% to 16% of the global population and is a leading cause of death. Appropriate screening, diagnosis, and management by primary care clinicians are crucial to prevent adverse outcomes such as cardiovascular disease, end-stage kidney disease, and mortality. CKD is defined by persistent abnormalities in kidney structure or function, such as a glomerular filtration rate (GFR) <60 mL/min/1.73 m² or albuminuria ≥30 mg per 24 hours, for more than 3 months. In developed countries, diabetes and hypertension are the most common causes. However, less than 5% of patients with early CKD are aware of their condition. Staging and risk assessment tools that incorporate GFR and albuminuria can guide treatment, monitoring, and referral strategies. Optimal management includes reducing cardiovascular risk, treating albuminuria, avoiding nephrotoxins, and adjusting drug dosing. Patients also require monitoring for complications such as hyperkalemia, metabolic acidosis, hyperphosphatemia, vitamin D deficiency, secondary hyperparathyroidism, and anemia. Referral to a nephrologist is recommended when eGFR falls below 30 mL/min/1.73 m² or albuminuria exceeds 300 mg per 24 hours. Early detection and management by primary care clinicians are essential to reduce the burden of CKD worldwide.Chronic Kidney Disease (CKD) affects 8% to 16% of the global population and is a leading cause of death. Appropriate screening, diagnosis, and management by primary care clinicians are crucial to prevent adverse outcomes such as cardiovascular disease, end-stage kidney disease, and mortality. CKD is defined by persistent abnormalities in kidney structure or function, such as a glomerular filtration rate (GFR) <60 mL/min/1.73 m² or albuminuria ≥30 mg per 24 hours, for more than 3 months. In developed countries, diabetes and hypertension are the most common causes. However, less than 5% of patients with early CKD are aware of their condition. Staging and risk assessment tools that incorporate GFR and albuminuria can guide treatment, monitoring, and referral strategies. Optimal management includes reducing cardiovascular risk, treating albuminuria, avoiding nephrotoxins, and adjusting drug dosing. Patients also require monitoring for complications such as hyperkalemia, metabolic acidosis, hyperphosphatemia, vitamin D deficiency, secondary hyperparathyroidism, and anemia. Referral to a nephrologist is recommended when eGFR falls below 30 mL/min/1.73 m² or albuminuria exceeds 300 mg per 24 hours. Early detection and management by primary care clinicians are essential to reduce the burden of CKD worldwide.
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