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Review
. 2018 Oct;64(10):728-735.

Approach to the detection and management of chronic kidney disease: What primary care providers need to know

Allan K Grill  1 , Scott Brimble  2
Affiliations
Review

Approach to the detection and management of chronic kidney disease: What primary care providers need to know

Allan K Grill et al. Can Fam Physician. 2018 Oct.

Abstract
in English, French

Objective: To help primary care providers, both family physicians and nurse practitioners, identify, detect, and manage patients with and at risk of chronic kidney disease (CKD), as well as outline criteria for appropriate referral to nephrology.

Sources of information: Published guidelines on the topic of CKD and its comorbidities were reviewed. A MEDLINE search was conducted using the MeSH terms chronic renal insufficiency, family practice, and primary health care. The search was limited to reviews and articles in English. The search covered all relevant articles from 2006 to the present.

Main message: The KidneyWise clinical tool kit, created by the Ontario Renal Network and available at www.kidneywise.ca, provides evidence-informed, practical guidance to primary care providers on the diagnosis and management of CKD. A component of this tool is an algorithm that offers a step-by-step approach to diagnosing and managing CKD. This resource will help empower providers to identify those at high risk of this condition, order appropriate diagnostic tests, help prevent further disease progression, and reduce comorbid cardiovascular risk in patients with CKD.

Conclusion: Most patients with CKD can be managed in primary care. Serial follow-up is essential to identify patients at high risk of progression to advanced stages of CKD, including end-stage renal disease. Primary care providers must continue to work together with local nephrologists to improve the lives of those living with CKD.

Objectif: Aider les professionnels des soins primaires, tant les médecins de famille que les infirmières praticiennes, à identifier, dépister et prendre en charge les patients atteints ou à risque d’une néphropathie chronique (NC), et présenter les critères justifiant une demande appropriée de consultation en néphrologie.

Sources de l’information: Les guides de pratique clinique publiés sur les NC et leurs comorbidités ont été passés en revue. Une recension dans MEDLINE a été effectuée au moyen des expressions MeSH chronic renal insufficiency, family practice et primary health care. La recherche documentaire s’est limitée aux revues et aux articles en anglais, et couvrait tous les articles pertinents de 2006 à aujourd’hui.

Message principal: La trousse d’outils cliniques KidneyWise, produite par le Réseau rénal de l’Ontario et accessible en anglais à www.kidneywise.ca, offre des conseils pratiques, éclairés par des données probantes, à l’intention des professionnels des soins primaires sur le diagnostic et la prise en charge des NC. Parmi les outils de la trousse se trouve un algorithme qui propose une approche par étapes à l’égard du diagnostic et de la prise en charge des NC. Cette ressource aidera les professionnels à identifier les personnes à risque élevé de contracter cette maladie, à prescrire les analyses diagnostiques appropriées, à freiner la progression de la maladie, et à réduire les risques cardiovasculaires concomitants chez les patients atteints de NC.

Conclusion: La plupart des patients souffrant d’une NC peuvent être pris en charge en soins primaires. Il est essentiel de procéder à un suivi périodique pour identifier les patients à risque élevé que leur maladie évolue vers des stades avancés, y compris la néphropathie au stade terminal. Les professionnels des soins primaires doivent continuer à travailler avec les néphrologues locaux pour améliorer la vie des personnes vivant avec une NC.

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Figures

Figure 1.
Figure 1.
Algorithm for identifying, detecting, and managing chronic kidney disease Reproduced from the Ontario Renal Network.
Figure 2.
Figure 2.
Current CKD nomenclature used by KDIGO: Classification of CKD is based on cause, GFR category, and albuminuria category. CKD—chronic kidney disease, GFR—glomerular filtration rate, KDIGO—Kidney Disease: Improving Global Outcomes. Reproduced with permission from the KDIGO Work Group.
Figure 3.
Figure 3.
The KDIGO CKD lipid guidelines for management of hyperlipidemia CAD—coronary artery disease, CKD—chronic kidney disease, DM—diabetes mellitus, KDIGO—Kidney Disease: Improving Global Outcomes. *Contraindications include acute liver disease, high alcohol consumption, or pregnancy. Women with child-bearing potential should only use a statin if there is reliable contraception. Data from KDIGO Lipid Work Group and Anderson et al.
See this image and copyright information in PMC

References

    1. Kidney Disease: Improving Global Outcomes (KDIGO) Work Group KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150. Available from: www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO_2012_CKD_GL.pdf. Accessed 2018 Aug 23.
    1. Levin A, Hemmelgarn B, Culleton B, Tobe S, McFarlane P, Ruzicka M, et al. Guidelines for the management of chronic kidney disease. CMAJ. 2008;179(11):1154–62. - PMC - PubMed
    1. Arora P, Vasa P, Brenner D, Iglar K, McFarlane P, Morrison H, et al. Prevalence estimates of chronic kidney disease in Canada: results of a nationally representative survey. CMAJ. 2013;185(9):E417–23. Epub 2013 May 6. - PMC - PubMed
    1. Kidney Strategic Clinical Network . Prevalence of severe kidney disease and use of dialysis and transplantation across Alberta from 2004 – 2013. Edmonton, AB: Alberta Health Services; 2015. Available from: www.albertahealthservices.ca/assets/about/scn/ahs-scn-kh-annual-kidney-c.... Accessed 2018 Aug 23.
    1. Ontario Renal Network . Ontario Renal Plan II: 2015–2019. Toronto, ON: Ontario Renal Network; Available from: www.renalnetwork.on.ca/common/pages/UserFile.aspx?fileId=333923. Accessed 2018 Aug 23.

MeSH terms