CKD: Management of Chronic Kidney Disease

[2014 new]

Introduction to this self-study CME activity

Purpose

Chronic kidney disease (CKD) is an increasingly common clinical problem that raises a patient’s risk for developing several life-threatening medical conditions, including end stage renal disease (ESRD) and cardiovascular disease (CVD). Appropriate treatment can delay or prevent these adverse outcomes. However, CKD is often not recognized by clinicians or patients and as a result is often not optimally treated.  This self-study activity provides practical guidance to clinicians about diagnosing and treating CKD in adults based on available empirical evidence.  Key aspects of care include:

 Screening and Diagnosis

  • Consider screening for CKD in patients with increased risk for CKD, e.g., those with diabetes, with hypertension, and age  > 55 years
  • For CKD diagnosis, staging, and follow-up, needed are both:
    • estimated glomerular filtrations rate (eGFR)
    • assessment for the presence or absence of albuminuria

 Treatment

  • Primary treatment to prevent progression to ESRD is blockade of the renin angiotensin aldosterone (RAA) system with either an angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB)
  • Blood pressure control:
    • for CKD patients without albuminuria, BP <140/90 reduces disease progression and cardiovascular mortality.  
    • for CKD patients with albuminuria, BP <130/80 may be beneficial
  • Manage comorbid conditions like diabetes and dyslipidemia – cardiovascular disease remains the leading cause of death among patients with CKD

 Monitoring and Follow Up

  • Timing and frequency of CKD monitoring and follow up depends on disease severity and risk for progression
  • Assess GFR and albuminuria a minimum of once per year.
  • Refer to nephrology patients:
  • with CKD stages G4 or G5 to nephrology for co-management and preparation for renal replacement therapy
  • at earlier stages for assistance with diagnosis of underlying cause and/or treatment of common complications of CKD.

Objectives

 Participants in this CME activity will understand and be able to implement evidence-based cost-effective clinical strategies for the diagnosis and treatment of CKD in adults. 

Audience

This self-study activity is appropriate for primary care clinicians and other health care providers who diagnose and treat CKD in adults.

Authors

Team Leaders

  • Jennifer Reilly Lukela, MD
    General Medicine

Team Members

  • R. Van Harrison, PhD
    Medical Education
  • Masahito Jimbo, MD
    Family Medicine
  • Ahmad Mahallati, MD
    Nephrology
  • Rajiv Saran, MBBS
    Nephrology
  • Annie Z. Sy, PharmD
    Quality Management Program

Author Disclosures

R. Van Harrison, PhD, Masahito Jimbo, MD, Jennifer Reilly Lukela, MD, Ahmad Mahallai, MD, and Annie Z. Sy, Pharm D have no personal financial relationship with a commercial interest (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients) in the past 12 months whose products or services are addressed in this guideline. Rajiv Saran, MBBS, receives research funding from Forest Pharmaceuticals and the Renal Research Institute.

Other Acknowledgements

UMHS Guidelines Oversight Team

  • Grant Greenberg, MD, MA, MHSA
  • R. Van Harrison, PhD

Literature Search Services

  • Taubman Medical Library

Production of Internet Format and Website Maintenance

  • Ellen Patrick-Dunlavey, MA

CME Accreditation and Credit Designation

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Michigan Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

This CME activity was released in March 2014, with credit available through February 2017.  The activity was reviewed for currency of content in March 2017 and availability of credit reauthorized and extended through February 2020. Continuation of credit from that date depends on a thorough review of the content currency and accuracy.

 

Method of Participation

  1. View the web pages. You may print the self-study text to read off-line.
  2. Complete the on-line learning assessment test with a score of 70% or higher.  After you initially take the test, the test will be immediately electronically scored. 
    If fewer than 70% of the questions are answered correctly, the questions that were not answered correctly will be noted in red.  Review the CME content related to those topics and retake the test.
    If 70% or more of the questions are answered correctly, the correct and incorrect answers for all questions will be shown along with explanations of the basis for the correct answer.  The link to register and receive credit is shown at the end of the items and explanations. 
  3. Complete the electronic credit request and activity evaluation.  An electronic certificate of participation will be provided immediately.
  4. Print the certificate of participation for your personal records.