Management of Chronic Kidney Disease
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Screening and Diagnosis
- Consider screening for CKD in patients with increased risk for CKD, e.g., those with diabetes, with hypertension, and age > 55 years
- For CKD diagnosis, staging, and follow-up, needed are both:
- estimated glomerular filtrations rate (eGFR)
- assessment for the presence or absence of albuminuria
- Primary treatment to prevent progression to ESRD is blockade of the renin angiotensin aldosterone (RAA) system with either an angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB)
- Blood pressure control:
- for CKD patients without albuminuria, BP <140/90 reduces disease progression and cardiovascular mortality.
- for CKD patients with albuminuria, BP <130/80 may be beneficial
- Manage comorbid conditions like diabetes and dyslipidemia – cardiovascular disease remains the leading cause of death among patients with CKD
Monitoring and Follow Up
- Timing and frequency of CKD monitoring and follow up depends on disease severity and risk for progression
- Assess GFR and albuminuria a minimum of once per year.
- Refer to nephrology patients:
- with CKD stages G4 or G5 to nephrology for co-management and preparation for renal replacement therapy
- at earlier stages for assistance with diagnosis of underlying cause and/or treatment of common complications of CKD.
The University of Michigan Medical School designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Release Date: March 2014,
Termination Date: July 2022
Continued availability of CME credit for this activity depends on a thorough review of its content every three years. This activity was last reviewed for currency and accuracy in July 2019, and availability of CME credit continued.
Jennifer Reilly Lukela, MD; General Medicine
R. Van Harrison, PhD; Medical Education
Masahito Jimbo, MD; Family Medicine
Ahmad Mahallati, MD; Nephrology
Rajiv Saran, MBBS; Nephrology
Annie Z. Sy, PharmD; Quality Management Program
Financial Disclosure Information:
Rajiv Saran, MBBS
Research Funding: Forest Pharmaceuticals, Renal Research Institute
There are no other relevant financial relationships to disclose for this CME activity.
UMHS Guidelines Oversight Team:
Karl T. Rew, MD
R. Van Harrison, PhD
Literature Search Services:
Taubman Medical Library