Chronic kidney disease (CKD), which is becoming increasingly prevalent in the US and worldwide, eventually progresses to end-stage renal disease (ESRD), requiring renal replacement therapy. Diabetes and hypertension, the two leading causes of CKD, are themselves reaching near epidemic proportions. Hypertension can cause both the development and progression of CKD, and CKD is a significant risk factor for the development of cardiovascular disease. Indeed, CKD patients are more likely to die of cardiovascular complications than progress to ESRD. However, data indicate that early recognition and management of CKD can have a significant positive impact on disease outcome. This creates an important interventional opportunity for the primary care physician. This report describes the major risk factors and comorbidities associated with the development and progression of CKD and offers suggestions for timely diagnosis and management of CKD in the primary care setting.
* Chronic kidney disease (CKD) is becoming increasingly prevalent, due in part to the increase in its two leading causes: diabetes and hypertension. CKD eventually progresses to end-stage renal disease (ESRD), a condition requiring renal replacement therapy such as dialysis or renal transplantation.
* CKD is a significant risk factor for cardiovascular disease (CVD).
* Treatable comorbidities such as proteinuria, hyperlipidemia, and anemia can exacerbate CVD in those with CKD and significantly hasten the progression of CKD to ESRD, increasing the risk of death.
* CKD in its early stages often goes unrecognized and is underdiagnosed, such that CKD patients are often referred to a specialist in the later stages of the disease.
* More patients with CKD die from cardiovascular complications than reach renal replacement therapy.
* Evidence shows that appropriate and timely management of traditional risk factors and comorbidities can result in increased quality of life and a decrease in the rate of progression to ESRD.
* Primary care physicians have an important opportunity, through the recognition of risk factors, for early screening and diagnosis of CKD. Appropriate treatment of associated comorbidities can delay CKD progression and improve disease outcome.
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