Chronic kidney disease: identification and management in primary care

Abstract

CKD is an important and common non-communicable condition globally. In national and international guidelines it is defined and staged according to measures of kidney function that allow for a degree of risk stratification using commonly available markers. It is often asymptomatic in its early stages and early detection is important to reduce future risk. The risk of cardiovascular outcomes is greater than the risk of progression to end stage kidney disease for most people with CKD. CKD also predisposes to acute kidney injury – a major cause of morbidity and mortality worldwide. Although only a small proportion of people with CKD progress to end stage kidney disease, renal replacement therapy (dialysis or transplantation) represent major costs for health care systems and burden for patients. Efforts in primary care to reduce the risks of cardiovascular disease, acute kidney injury and progression are therefore required. Monitoring renal function is an important task and primary care clinicians are well placed to oversee this aspect of care along with the management of modifiable risk factors, particularly blood pressure and proteinuria. Good primary care judgement is also essential in making decisions about referral for specialist nephrology opinion. As CKD commonly occurs alongside other conditions, consideration of comorbidities and patient wishes is important and primary care clinicians have a key role in coordinating care while adopting a holistic, patient-centred approach and providing continuity. This review aims to summarise the vital role that primary care plays in pre-dialysis CKD care and to outline the main considerations in its identification, monitoring and clinical management in this context.

More information

Identifiers

ORCID for Simon D.S. Fraser: orcid.org/0000-0002-4172-4406

Catalogue record

Export record

Altmetrics