Manage Patients with Chronic Kidney Disease

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 or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 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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