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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

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

Manage Patients With CKD

Management of CKD involves an interdisciplinary approach. Monitoring trends in urine albumin-to-creatinine ratios (UACR) and estimated glomerular filtration rates (eGFR) may be used to assess response to interventions. Medical interventions that may help slow progression include control of blood pressure, use of medications that block the renin-angiotensin-aldosterone system (RAAS) to lower urine albumin; and glucose control in those with diabetes. Interventions may include nutrition therapy, lifestyle modification, and self-management education.

Identification and treatment of CKD complications may help improve quality of life. Complications include, but are not limited to, cardiovascular disease; anemia; malnutrition; mineral and bone disorders; depression and reduced functional status. Due to the complex nature of CKD, referrals to the appropriate health care provider, including a nephrologist, may be beneficial to the person with kidney disease.

Knowledge of kidney function is important for dosage of medications that are excreted by the kidneys. Food and Drug Administration (FDA)-approved drug-labeling guides provide adjustments of drug dosages for patients with impaired kidney function. On these labels, serum creatinine; measured creatinine clearance (CrCl); or, most commonly, estimated creatinine clearance using the Cockcroft-Gault equation (eCrCl) are used to estimate kidney function. For most drugs, these labels were developed prior to standardized calibration of creatinine assays and reporting estimated glomerular filtration rate (eGFR) calculated using the Modification of Diet in Renal Disease (MDRD) Study equation. CKD and Drug Dosing: Information for Providers describes NKDEP’s suggestions and rationales for assessment of kidney function for drug-dosing purposes.

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References »

Adler AI, Stevens RJ, Manley SE, et al. Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney International. 2003;63(1):225–232.

Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary Care. Journal of the American Medical Association. 2002; 288: 2469-2475.

de Zeeuw D, Remuzzi G, Parving HH, et al. Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: lessons from RENAAL. Kidney International, 2004; 65(6):2309-2320.

Fouque D, Guebre-Egziabher F. Do low protein diets work in chronic kidney disease patients? Seminars in Nephrology. 2009; 29(1):30-38.

Johansen KL. Exercise and Chronic Kidney Disease. Sports Medicine. 2005;35(6):485-499.

Kalantar-Zadeh K, Getekunst L, Mehrotra R, et al. Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease. Clinical Journal of the American Society of Nephrology. 2010; 5(3):519-530.

Lorig KR, Holman HR. Self-Management Education: History, Definitions, Outcomes, and Mechanisms. Annals of Behavioral Medicine. 2003; 26:1-7.

Molitch ME, Steffes M, Sun W, et al. Development and progression of renal insufficiency with and without albuminuria in adults with type 1 diabetes in the Diabetes Control and Complications Trial and the Epidemiology of Diabetes Interventions and Complications Study. Diabetes Care. 2010;33(7):1536–1543.

Orth SR, Hallan SI. Smoking: a risk factor for progression of chronic kidney disease and for cardiovascular morbidity and mortality in renal patients – absence of evidence or evidence of absence? Clinical Journal of the American Society of Nephrology. 2008; 3:226-236.

Shurraw S, Hemmelgarn B, Lin M, et al. Association between glycemic control and adverse outcomes in people with diabetes mellitus and chronic kidney disease. Archives of Internal Medicine. 2011; 171(21):1920-1927.

U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th ed. Washington, D.C.: U.S. Government Printing Office, December 2010. U.S. Department of Agriculture website.
http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf.

  • Addressing CKD in Patients with Multiple Chronic Conditions

    An image of a health professional speaking with a patient

    Watch a presenation from NKDEP Director Dr. Andrew Narva on caring for CKD patients with multiple chronic conditions.

  • Your Kidney Test Results

    A "report card" to help patients monitor their labs. Download.

Page last updated: June 6, 2012