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Practical recommendations for treating patients with chronic kidney disease in Australia: a multidisciplinary
M P Schlaich1, W P Abhayaratna2, R Audehm3
1Dobney Hypertension Centre, Medical School, University of Western Australia - Royal Perth Hospital and RPH Research Foundation, Perth, Western Australia, Australia.
Insights
Australian healthcare practitioners can improve chronic kidney disease (CKD) management with new evidence-based recommendations. These guidelines focus on regular monitoring, risk factor control, and timely specialist referral for better patient outcomes.
Area of Science:
- Nephrology
- Public Health
- Evidence-Based Medicine
Background:
- Chronic kidney disease (CKD) affects 10% of Australian adults, frequently co-existing with diabetes, hypertension, and cardiovascular disease.
- Management complexities and existing guidelines may not fully address the Australian healthcare context.
- Pharmacological advances, especially for diabetic kidney disease (DKD), offer improved clinical outcomes.
Purpose of the Study:
- To create practical, evidence-based recommendations for Australian healthcare practitioners.
- To enhance the management of chronic kidney disease (CKD) across all care levels in Australia.
Main Methods:
- A multidisciplinary panel of eight healthcare professionals was convened.
- An adapted virtual nominal group technique was used to reach consensus on recommendations.
Main Results:
- Nine unique recommendations for CKD management were developed.
- Key recommendations include regular assessment of urine albumin-to-creatinine ratio (uACR) and estimated glomerular filtration rate (eGFR) for at-risk patients.
- Proactive management of cardiometabolic risk factors and consideration of the four pillars of therapy for DKD were emphasized.
Conclusions:
- The consensus recommendations offer actionable guidance for Australian healthcare practitioners.
- These guidelines aim to improve CKD management within the Australian healthcare system.
- The recommendations address the specific needs of managing CKD in Australia.
Background:
Chronic kidney disease (CKD) is a significant public health challenge in Australia, affecting ~10% of the adult population and contributing to substantial morbidity and mortality. Diabetes, hypertension, cardiovascular disease and CKD frequently co-exist; therefore, a multidisciplinary approach is necessary to manage these conditions. Recent advances in pharmacological therapies, particularly for diabetic kidney disease (DKD), can improve clinical outcomes. Current guidelines may not fully address the complexities of CKD management across all levels of care in the Australian context.
Objective:
To develop simple, practical, evidence-based recommendations to guide healthcare practitioners in improving CKD management across Australia.
Methods:
A multidisciplinary panel of eight healthcare practitioners (nephrologists, cardiologists, endocrinologists and general practitioners) employed an adapted virtual nominal group technique to achieve consensus on CKD management recommendations.
Results:
The panel developed nine unique recommendations; five achieved consensus, and four were in accordance with GRADE guidance: Both urine albumin-to-creatinine ratio (uACR) and estimated glomerular filtration rate (eGFR) should be assessed regularly in patients at increased CKD risk. Most patients with CKD can be managed in primary care, with specialist referral when required. Ensure all cardiometabolic risk factors are assessed and managed proactively. For patients with diabetic kidney disease, consider the four pillars of therapy.
Conclusion:
These multidisciplinary consensus recommendations provide actionable guidance for Australian healthcare practitioners to improve CKD management across all levels of care, addressing the unique needs of the Australian healthcare landscape.
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