Management of chronic kidney disease in primary health care: position paper of the European Forum for Primary Care.

Abstract

Chronic kidney disease (CKD) is a worldwide public health problem that is often underdiagnosed and undertreated. CKD is a ‘silent’ disease and goes unnoticed because it may not be ‘felt’. Yet it affects many more people than wemight imagine: 1 out of 10 adults in the world has some form of kidney damage. However, as many as 90% of those who have CKD remain unidentified. High blood pressure and diabetes are the main causes of CKD. It is projected that diabetes will increase by 70% by 2025. Therefore, early detection and prevention of the progression of CKD for people who also have a very high cardiovascular risk are extremely important challenges and goals for general practitioners/family doctors (GPs/FDs). CKD represents a progressive, irreversible decline in glomerular filtration rate (GFR). Most chronic nephropathies unfortunately lack a specific treatment and progress relentlessly to end-stage renal disease (ESRD). Progressive renal function loss is a common phenomenon in renal failure, irrespective of the underlying cause of the kidney disease. The kidney is able to adapt to damage by adaptive hyperfiltration – increasing the filtration in the remaining normal nephrons. As a result, a patient with mild renal insufficiency often has a normal or near-normal serum creatinine concentration. Adaptive hyperfiltration, although initially beneficial, appears to result in long-term damage to the glomeruli of the remaining nephrons, which is manifest by proteinuria and progressive renal insufficiency. This process appears to be responsible for the development of renal failure among those in whom the original illness is either inactive or cured. The cost of the advanced renal failure and renal replacement therapy is enormous. Therefore, early diagnosis and optimalmanagement of CKD affordsmany challenges for primary health care in helping to maintain health and quality of life among the population at risk. This position paper is based on published reviews about CKDmanagement in different stages, and focuses on key references published since the year 2000. This position statement also provides evidence-based screening recommendations and interventions for shared care between GPs/FDs and specialists.