Chronic kidney disease, which affects up to 37 million Americans each year, is known to be a risk multiplier for other afflictions, especially cardiovascular disease. Adults with chronic kidney disease – or CKD – are also at risk of acute kidney injury, CKD metabolic acidosis and CKD mineral and bone disorder, yet as many as 9 in 10 with the disease don’t know they have it, according to the Centers for Disease Control and Prevention (CDC).
The goals of medical management are to decrease the risk of CKD and to prevent the progression of the disease in those who are diagnosed.
One of the objectives of medical management is to monitor patients who are at risk for CKD. These patients include diabetics, hypertensives, and those who have a family history, belong to certain ethnic groups (Black, Hispanic and most Indigenous people), are 60 and older or who may have heart disease. Early diagnosis is key to improving outcomes.
Among ways medical providers can prevent, treat and control CKD include:
- Treating reversible causes of kidney failure, such as volume depletion, drug-related injury, obstruction or interstitial nephritis
- Controlling hypertension, maintaining good glycemic control, and managing CKD anemia, CKD mineral and bone disorder, and CKD metabolic acidosis
- Individualized control of blood pressure using an appropriate range for the patient, including the use of ACE inhibitors (ACEi) or angiotensin receptor blockers (ARB) for patients with hypertension and albuminuria
- Controlling diabetes with an aim of a hemoglobin A1c < 7 and a referral for nutrition therapy
- Controlling lipid, phosphate (PO4) and uric acid
- Recommending lifestyle changes, such as adding exercise, monitoring food choices and engaging in discussion with other CKD patients
- Assessing social determinants of health stressors to reveal barriers to patients receiving needed care
- Educating patients regarding the use of nonsteroidal anti-inflammatory drugs (NSAIDS), both prescribed and over the counter, herbal remedies or the use of performance-enhancing preparations (especially in athletes), and training patients to ask about medications prescribed by other providers to prevent the use of nephrotoxic medications
There are multiple recommendations made for the management of CKD and it is challenging to implement all of them for any one patient. Flexibility and co-management with a team of health care professionals may provide the best management strategy.
Don't forget to register for our third and final webinar in the CKD Education Series: Management on Aug. 26, 2021, at noon PT/1 p.m. MT.
For more information, contact Senior Improvement Advisor Gwen Cox.