Approach to the detection and management of chronic kidney disease: What primary care providers need to know.
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OBJECTIVE: To help primary care providers, both family physicians and nurse practitioners, identify, detect, and manage patients with and at risk of chronic kidney disease (CKD), as well as outline criteria for appropriate referral to nephrology. SOURCES OF INFORMATION: Published guidelines on the topic of CKD and its comorbidities were reviewed. A MEDLINE search was conducted using the MeSH terms chronic renal insufficiency, family practice, and primary health care. The search was limited to reviews and articles in English. The search covered all relevant articles from 2006 to the present. MAIN MESSAGE: The KidneyWise clinical tool kit, created by the Ontario Renal Network and available at www.kidneywise.ca, provides evidence-informed, practical guidance to primary care providers on the diagnosis and management of CKD. A component of this tool is an algorithm that offers a step-by-step approach to diagnosing and managing CKD. This resource will help empower providers to identify those at high risk of this condition, order appropriate diagnostic tests, help prevent further disease progression, and reduce comorbid cardiovascular risk in patients with CKD. CONCLUSION: Most patients with CKD can be managed in primary care. Serial follow-up is essential to identify patients at high risk of progression to advanced stages of CKD, including end-stage renal disease. Primary care providers must continue to work together with local nephrologists to improve the lives of those living with CKD.
