Chronic kidney disease for the primary care provider

Area of Science:

• Nephrology
• Public Health
• Primary Care Medicine

Background:

• Chronic kidney disease (CKD) affects 15% of U.S. adults and 9% globally, exacerbated by aging, diabetes, and hypertension.
• Primary care providers (PCPs) are vital for early CKD identification and management due to their patient relationships.

Purpose of the Study:

• To provide a comprehensive framework for CKD management in primary care.
• To synthesize current evidence on CKD diagnosis, risk prediction, and treatment.

Main Methods:

• Review of current evidence on CKD diagnosis and staging using estimated glomerular filtration rate (eGFR) and albuminuria.
• Analysis of risk-based screening strategies for high-risk populations.
• Synthesis of evidence-based pharmacotherapies for CKD management.

Main Results:

• PCPs can utilize eGFR and albuminuria for accurate CKD diagnosis and staging.
• Pharmacotherapies including RAAS inhibitors, SGLT2 inhibitors, MRAs, and GLP-1 RAs are key treatment components.
• Risk-based referral strategies integrating eGFR decline, albuminuria, and risk equations optimize specialist care.

Conclusions:

• PCPs can significantly slow CKD progression, reduce cardiovascular risks, and coordinate care.
• Effective primary care management of CKD is essential to address the growing global burden of kidney disease.
• Shared decision-making and polypharmacy management are critical aspects of PCP-led CKD care.