The primary care role in detection, management, and reducing the risk of progression of CKD continues to expand. Test yourself here on basics in each category.
Chronic Kidney Disease: 7 Questions on Detection, Management, and Reducing Risk of Progression for Primary Care
Question 1. In the general population, the prevalence of CKD is estimated to be at least which of the above?
Answer: E. 10%. Recent population estimates put the prevalence of CKD at >10%--a burden that outstrips the capacity of nephrology specialists. Primary care clinicians will play an increasingly large role in managing most CKD patients in clinical practice.
Answer D. A or C. Chronic kidney disease is defined as a GFR of <60 mL/min/1.73 m2 and/or markers of kidney damage such as albuminuria, imaging abnormalities, or biopsy findings for 3 months or more.
Answer: B. Diabetes. Expert consensus is that evidence is insufficient to support general population screening for CKD; however, the American Diabetes Association recommends screening of all diabetes patients. In addition, several groups recommend screening patients who are being treated for hyperrtension.
Question 4. Which of the above is required to prevent CKD progression in a patient with diabetes and hypertension?
Answer: E. All of the above. Prevention of CKD progression requires a multifactorial approach. Key aspects of care include maintaining a blood pressure <140/90 mm Hg and correction of metabolic acidosis associated with CKD. For CKD patients with diabetes, a hemoglobin A1c of ≤7% is optimal, while patients with albuminuria or hypertension should receive ACEis or ARBs.
Answer: A. NSAIDs. NSAID use is associated with acute kidney injury, while long term use can increase the rate of CKD progression. The panel of internists and nephrologists recommended that NSAID use be limited in CKD patients and avoided when GFR is <30 mL/min/1.73 m2.
Answer: A. Spot albumin-to-creatinine ratio. Albuminuria is common in CKD and can be an early marker of kidney damage. Although both measurements can help predict clinical outcomes, the spot albumin-to-creatinine ratio is more sensitive and specific, the expert panel said in its report.
Answer: C. eGFR drop of 25%. Indications for nephrology referral include a drop in eGFR of 25% or more, GFR of <30 mL/min/1.73 m2, and persistent unexplained hematuria. Check out the full set of recommendations by Vassalotti et al for more details on optimal primary care management and referral of CKD.
Citation: Vassalotti JA, Centor R, Turner BJ, et al. Practical approach to detection and management of chronic kidney disease for the primary care clinician. Am J Med. 2016;129:153–162.e7
Detecting and managing chronic kidney disease (CKD) can be challenging for the primary care clinician but with fewer nephrologists to handle this population, you'll likely be seeing these patients more often, for longer. How much do you know about CKD? To find out, take this quiz, which is based on recent recommendations from an expert panel of internists and nephrologists. To get started, advance the first slide below to Question 1.