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Management of Chronic Kidney Disease

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Step Status
Educational Materials
Release Date: Mon, 1/1/18
Termination Date: Sun, 7/31/22
Credits: 1
Description: Chronic kidney disease (CKD) is an increasingly common clinical problem that raises a patient's risk for developing several life-threatening medical conditions, including end stage renal disease (ESRD) and cardiovascular disease (CVD). Appropriate treatment can delay or prevent these adverse outcomes. However, CKD is often not recognized by clinicians or patients and as a result is often not optimally treated. This self-study activity provides practical guidance to clinicians about diagnosing and treating CKD in adults based on available empirical evidence. Key aspects of care include:

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.

Educational Objectives: Participants in this CME activity will understand and be able to implement evidence-based cost-effective clinical strategies for the diagnosis and treatment of CKD in adults.
Target Audience: This self-study activity is appropriate for primary care clinicians and other health care providers who diagnose and treat CKD in adults.
Accreditation Information: The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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.

Additional Info: Authors:
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

Credits available:

AMA PRA Category 1: 1.00
Participation: 1.00