Feature Article

Chronic kidney disease: detection, prevention and early-stage management

EDMUND CHUNG, JEFFREY HA, KAREN POK, Grant Luxton

Figures

© MOHAMMED HAnEEFA nIZAMUDEEn/ISTOCKPHOTO.COM
© MOHAMMED HAnEEFA nIZAMUDEEn/ISTOCKPHOTO.COM

Abstract

Chronic kidney disease (CKD) is an increasing problem among our ageing population and is associated with significant cardiovascular morbidity and mortality. Targeted screening and optimal early management of patients in primary care can prevent the worst outcomes of CKD.

Key Points

  • Estimated glomerular filtration rate and albuminuria should both be used to predict risk of chronic kidney disease (CKD) progression and are both independently associated with an increased risk of cardiovascular disease and mortality.
  • Recommended assessment before referral to a nephrologist includes measuring blood pressure (BP), biochemical and haematological testing, urinary albumin to creatinine ratio, urine microscopy for red cell morphology and casts, and urinary tract ultrasound.
  • BP control in patients with CKD should be optimised according to cardiovascular risk while balancing the risks of more intensive BP treatment.
  • Sodium-glucose cotransporter-2 inhibitors should be considered in high-risk patients with diabetic kidney disease and macroalbuminuria due to their renal and cardiovascular benefits.
  • Patients with CKD commonly have hyperuricaemia but should only be prescribed urate-lowering therapy if they already have gout or urate calculi.
  • Salt restriction and the Dietary Approach to Stop Hypertension diet are recommended in hypertensive patients. Persistent hyperkalaemia and hyperphosphataemia may warrant input from a nephrologist and dietitian.
  • Parenteral or oral iron should be used to treat anaemia associated with CKD. Metabolic acidosis may be treated with oral sodium bicarbonate.

Figures

© MOHAMMED HAnEEFA nIZAMUDEEn/ISTOCKPHOTO.COM
© MOHAMMED HAnEEFA nIZAMUDEEn/ISTOCKPHOTO.COM