In a recent review published in the journal BMC Nephrology, Marcus G. Bastos and Gianna Mastroianni Kirsztajn from the Universidade Federal de Juiz de Fora and the Universidade Federal de São Paulo in Brazil, discussed the complexity of chronic kidney disease (CKD) and the multiplicity of interventions currently recommended for the secondary prevention of the condition, as well as the different models of healthcare delivery. The researchers also examined the outcomes of CKD patients followed in interdisciplinary care (IDC) clinics.
Chronic kidney disease (CKD) is a common condition that is more prevalent in the elderly population. Usually CKD in younger patients is associated with loss of kidney function, however 30% of CKD patients over 65 years of age do not have progressive disease with loss of kidney function over time. CKD is associated with an increased risk of cardiovascular disease and chronic renal failure, accounting for the ninth leading cause of death in the United States.
CKD progression in patients with different renal pathologies who are under nephrological care can be delayed or even halted by various measures. These include the strict control of blood pressure and the use of drugs that block the renin-angiotensinaldosterone system (RAAS). In addition, epidemiological studies in patients at risk for CKD have revealed that disease prevalence is much higher than previously believed.
In the review entitled “Chronic kidney disease: importance of early diagnosis, immediate referral and structured interdisciplinary approach to improve outcomes in patients not yet on dialysis”, the authors mention that currently CKD is defined on the basis of changes in the glomerular filtration rate and/or the presence of parenchymal damage for at least three months. They further consider that although CKD diagnosis is now quite straightforward, the proportion of patients with end-stage renal disease seen by a nephrologist for the first time immediately before the initiation of dialysis is still unacceptable.
CKD is a problem of great clinical relevance and is recognized as a complex disease demanding multiple facets in its management. When considering patient care, the authors mentioned that optimal CKD management is based on three pillars: 1) early diagnosis of disease, 2) immediate referral for nephrological treatment, and 3) implementation of measures to preserve renal function.
These three foundations are considered fundamental for patients with CDK because they rest on its early diagnosis and timely referral to nephrological care and treatments, which slow progression of the disease and prevent cardiovascular complications. According to the authors, to accomplish these goals it is important to estimate glomerular filtration rate (GFR) and measure albuminuria regularly in those patients at risk of CKD, implement early referral of recent diagnosed cases for conjunct follow-up with nephrology specialists, and guarantee good treatment of blood pressure, proteinuria, diabetes, weight, anemia, secondary hyperparathyroidism, anemia, dyslipidemia, and malnutrition.
Despite the translation of evidence-based medicine into daily practice, resulting into significant advances in the treatment of CKD, the authors consider it is necessary that patients starting renal replacement therapy (RRT) be more prepared. Furthermore, they highlight the need to decrease the rates of mortality and hospitalization. Early diagnosis, immediate referral, and implementation of measures to slow/halt CKD progression are among the key strategies to improve patients’ outcomes. The authors indicated that, “The sad observation, however, is that chance of death overcomes RRT as CKD progresses, even when patients have standard medical care. IDC model by offering a comprehensive organized care seems to be the best way to manage CKD, though more studies are advisable.”