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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Improving the understanding, detection, and management of kidney disease.

A doctor examines her patient's file

Identify and
Manage Patients

Chronic kidney disease (CKD) is best identified and treated early as part of comprehensive primary medical care. Goals of medical management are to: identify and treat, monitor, slow progression, and reduce and treat complications. Additional goals include providing patient education about CKD, diet, lifestyle, and preparation for renal replacement therapy (RRT).

Evaluate Patients with CKD »

Urine and blood tests are used to detect and monitor kidney disease. The key markers are abnormal urine albumin levels and a persistent reduction in the estimated glomerular filtration rate (eGFR). Identification of the etiology may help guide management. Early detection and appropriate treatment may improve prognosis in all age groups.

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Manage Patients with CKD »

Management of CKD involves an interdisciplinary approach. Monitoring trends in urine albumin-to-creatinine ratio (UACR) and eGFR are used to assess response to interventions. Medical interventions include control of blood pressure, use of medications that block the renin-angiotensin-aldosterone system; and glucose control in those with diabetes. Complications include cardiovascular disease, anemia, malnutrition, mineral and bone disorders, depression, and reduced functional status.

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Prepare for Renal Replacement Therapy »

Patients who develop kidney failure may benefit from early education about RRT. Early education gives the patient time to process the information and prepare both psychologically and physically. Treatment options include conservative management (no dialysis), hemodialysis, peritoneal dialysis, and kidney transplantation.

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Collaborative Approach to CKD Care »

Appropriate care for patients diagnosed with chronic kidney disease (CKD) requires collaborative, interdisciplinary care including all the health professionals in the primary care setting. Collaborative management by primary care providers and consultants like nephrologists and registered dietitians (RDs), can help maintain continuity of care and improve outcomes.

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CKD & Nutrition »

The purpose of medical nutrition therapy (MNT) for CKD is to maintain good nutritional status, slow progression, and to treat complications. The key diet components to slowing progression of CKD are controlling blood pressure by reducing sodium intake, reducing protein intake, if excessive, and managing diabetes. NKDEP offers clinical reference and training tools for registered dietitians, as well as educational materials to use in MNT.

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Considerations for Pediatric Patients »

Because routine urinalysis is no longer recommended as part of routine pediatric care, some children who would benefit from a urinalysis may not undergo this simple test. As a result, children with kidney disease may go undetected or not receive appropriate follow up. Urinalysis is important for pediatric patients who have one or more CKD risk factors. NKDEP offers educational materials for health professionals and parents of at-risk patients that encourage screening for CKD.

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Professional and Patient Education »

Effective management of CKD requires both prepared health care providers and informed patients. NKDEP has developed numerous resources to expand CKD knowledge among providers and support patient education efforts. This section includes resources for both professional and patient education, including communication skills modelling videos; trainings for pharmacists, diabetes educators, and registered dietitians; lesson plans for educating patients, and a program for community health workers.

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Quality Improvement in Primary Care Settings »

NKDEP supports addressing chronic kidney disease (CKD) in the primary care setting, as managing CKD prior to referral can improve outcomes. Many CKD interventions are similar to those for diabetes (e.g., glucose control), and other key interventions (e.g., co-morbidity screening) can be handled in primary care settings. Equipping providers in those settings with resources to better detect and treat CKD is an NKDEP priority.

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Page last updated: September 24, 2014