Early Identification and Management of Chronic Kidney Disease: A Narrative Review of the Crucial Role of Primary Care Practitioners.

ABSTRACT

Early-stage (stage 1-3) chronic kidney disease (CKD) has an asymptomatic presentation such that most people with CKD are unaware of their disease status and remain undiagnosed. CKD is associated with multiple long-term conditions (MLTC), or multimorbidity, the most common of these being cardiovascular disease, hypertension, and type 2 diabetes. Primary care practitioners (PCPs) are crucial in the early identification and management of patients with CKD. For individuals at high risk of CKD, measurements of estimated glomerular filtration rate, urine albumin-creatinine ratio, and blood pressure should be obtained regularly and recorded in a timely manner. The importance of lifestyle changes in the prevention and management of CKD should also be highlighted. A recent addition to the treatment of CKD in people with and without type 2 diabetes has been the recommendation by clinical practice guidelines of a sodium-glucose co-transporter 2 (SGLT2) inhibitor alongside a renin-angiotensin-aldosterone system inhibitor as foundational therapy. SGLT2 inhibitors prevent CKD progression and reduce fatal and non-fatal kidney and cardiovascular events, hospitalization for heart failure, and all-cause mortality, and they have a favorable safety and tolerability profile. However, uptake has been slow, particularly in people with CKD without type 2 diabetes. A multifaceted approach is required to ensure that people with CKD receive optimal kidney protection. Measures to raise awareness of the importance of early identification and intervention include local/national campaigns via social media and practice-based education; clinical education programs; integration of clinical decision support tools into electronic health records; detection programs built around electronic health records; and good interdisciplinary communication. PCPs at the forefront of multidisciplinary care are best placed to implement the evidence-based clinical practice CKD guidelines for lifestyle modification and guideline-directed medical therapy.

Chronic kidney disease, or CKD, affects about one in ten adults worldwide. Results from many real-world studies show that early identification and treatment of CKD is crucial to prevent the disease from getting worse. However, because CKD can have no symptoms in its early stages, it is often not diagnosed. Many people with CKD are therefore unaware that they have it. People with CKD are likely to have other long-term health issues as well, including cardiovascular disease, hypertension and diabetes. Primary care practitioners are best placed to offer holistic, patient-centered care to those with CKD, and are the frontline in identifying and managing the risk factors for chronic disease. Primary care practitioners may advise people with CKD on lifestyle changes, such as diet and exercise, as well as helping them understand what treatments are available. Sodium­glucose co-transporter 2 inhibitors have shown strong kidney-protective effects in clinical trials, and recently updated clinical guidelines recommend their use as foundational therapy alongside more established treatments of CKD. These treatments should be prescribed to people with CKD whether they have diabetes or not. For people at high risk of CKD, primary care practitioners should regularly obtain and record measurements of kidney function and blood pressure. Public and primary care practitioner awareness and education, the use of clinical decision support tools, and good communication between healthcare professionals are all important to drive change in primary care and improve the early identification and management of CKD.