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Now you have found Chronic Kidney Disease, what do you do? Nephrologist Dr Richard Baer discusses approaches.

Tuesday 25 July 2017

Now you have found Chronic Kidney Disease, what do you do? Nephrologist Dr Richard Baer discusses approaches.

The growing burden of Chronic Kidney Disease (CKD) means we will all come across this diagnosis in our day to day work. 

Most recent estimates show one in 10 Australians have CKD and nine out of 10 of these people are unaware they have it. CKD is common and harmful, yet treatable.

Finding CKD with a Kidney Health Check (screening with triad of eGFR, ACR, and BP) is the first step. But once you’ve found it, what do you do? 

Documents, booklets and apps have been used to get CKD assessment and management messages to primary carers and hospital doctors. 

Smart phone users can download KHA’s CKD Go! app, which is an intuitive way of negotiating the Chronic Kidney Disease Management in General Practice guidelines. The CKD Go! app is available for download from iTunes or Google Play. The guidelines are also available in a PDF via the KHA website. Health care and patient information is also available at www.kidney.org.au

Stages of CKD Risk Matrix:

Improve sophistication and communication in your problem list by converting CKD into Stage 3a CKD with microalbuminuria secondary to diabetic nephropathy.

Risk matrices with familiar colours as seen on the table, are based around the eGFR (CKD stage 1, 2, 3a, 3b, 4, or 5) and albuminuria level (normal, micro- or macroalbuminuria). 

This reminds us that both CKD stage and albuminuria are strong independent risk factors/markers for progression to End Stage Kidney Disease (ESKD) and cardiovascular events (stronger than conventional risk factors such as smoking, obesity, hypertension).

These are so strong that beyond 3b and microalbuminuria, there is little value in standard cardiovascular risk calculators as they are already in the highest risk category (greater than 15 per cent of a cardiovascular event in next five years).

Colour coding also directs to action plans for various risk categories, and directs thought processes to appropriate clinical management strategies, not routinely learnt through heavy glomerular histology or tubular physiology lectures.

Goals of management:

Following the yellow, orange, or red clinical action plan will take you through the relevant strategies to help optimise your patients’ care. The action plan will still require your input into diagnosis and individualisation of care.

Referral guidelines and valuable tests, such as routine bloods, Urine Albumin:Creatinine Ratio (ACR), Protein:Creatinine Ratio (PCR), and microscopy, Renal Imaging Ultrasound Scan (USS), and other useful diagnostic tests prior to referral are also included in the CKD Go! App and the referral guidelines. 

If you have any further doubts or questions friendly nephrologists would be more than happy to give you some advice or direction.

Article written by Dr Richard Baer. 

Reference: Chronic Kidney Disease (CKD) Management in General Practice (3rd Edition). Kidney Health Australia, Melbourne, 2015.

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