The Management of Chronic Kidney Disease not Requiring Renal Replacement Therapy in General Practice

Abstract

Background: Chronic kidney disease (CKD) is common in the German adult population, with a prevalence of 10%. This guideline, updated on the basis of current scientific evidence, contains recommendations for the management of CKD in general practice.

Methods: The updated guideline is based on a review and assessment of source guidelines and systematic reviews concerning individual questions. The recommendations were agreed upon in a moderated two-stage nominal group process by the mandate holders of the participating specialist societies, along with patient representatives.

Results: The risk of progression to renal failure requiring renal replacement therapy should be assessed with a risk score. Assessing this risk and determining the indication for treatment with SGLT2 inhibitors both require measurement of the urinary albumin-tocreatinine ratio. Pharmacotherapy is not recommended for asymptomatic hyperuricemia. An initial ultras - onographic examination of the kidneys and urogenital system is now recommended for all patients. The vaccination recommendations that differ for people with CKD have been integrated into the guideline.

Conclusion: The risk assessment of CKD and the treatment options have been expanded. The updated guideline can improve primary care for patients with CKD and the selection of patients for interdisciplinary care.

Figure 1

KDIGO categories with color coding of the risk of kidney failure. The risk figures, which usually are not shown, are calculated from the data in the source publication (6) and indicate the risk of renal failure per 1000 patients over the period of 1 year. *1 Description and range of estimated glomerular filtration rate (eGFR, mL/min/1.73 m²) *2 Compared to a young adult. *3 Description and range of urinary albumin–creatinine ratio (UACR)

Figure 2

Procedural flow chart for patients with suspected kidney disease (1) CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; UACR, urinary albumin–creatinine ratio

Figure 3

Decision-making aid for referral to nephrologist (1) CKD, chronic kidney disease; CKD-MBD, chronic kidney disease with mineral and bone disorder; eGFR, estimated glomerular filtration rate

Figure 4

Flow chart of procedure in patients with established CKD (1) ACE, angiotensin-converting enzyme; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; NVL, German National Clinical Guideline (Nationale Versorgungsleitlinie); RAAS, renin–angiotensin–aldosterone system; RSV, human respiratory syncitial virus; UACR, urinary albumin–creatinine ratio

Figure 5

Decision-making aid for prescribing an SGLT2 inhibitor (1) UACR, urinary albumin–creatinine ratio; SGLT2, sodium glucose cotransporter 2

eFigure

Recommendations for monitoring frequency (number of check-ups per year) based on GFR and albuminuria category-based recommendations for number of monitoring checks per year modified according to NICE (1, 8) *1 Description and range of eGFR (mL/min/1.73 m²) *2 Compared to a young adult. *3 Description and range of UACR. CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; UACR, urinary albumin–creatinine ratio