Chronic kidney disease is a major p...

Chronic kidney disease is a major public health question throughout the world. In the United States, kidney failure is becoming increasingly and is associated with poor health issues and high medical expenditures. In this nation the number of patients treated with dialysis or transplantation is throwed to increase from 340,000 in 1999 to 651000 in 2010 (1)

The major results of chronic kidney disease, regardless of the specific diagnosis (i.e., mark of kidney disease), include progression to kidney failure, complications from decreased kidney function, and unravelling of cardiovascular disease. Increasing evidence exhibits that early detection and treatment many times can prevent or delay a certain of these adverse outcomes. (2) However, opportunities for prevention may be forfeited because chronic kidney disease is not diagnosed or is treated insufficiently. (3-6) undivided reason is lack of agreement about the definition of chronic kidney disease, as well as the classification of its stages. Another reason is lack of uniform application of simple standards for the detection and evaluation of the disease.

In February 2002 the Kidney Disease result Quality Initiative (K/DOQI) of the National Kidney Foundation (NKF) (78) published clinical practice guidelines onward chronic kidney disease. The goals of the Work form into groups that developed the guidelines were as follows: to define chronic kidney disease and classify its stages, regardless of the underlying cause; to evaluate laboratory measurements for clinical assessment of kidney disease; to associate the flush of kidney function with the complications of chronic kidney disease; and to stratify risk for the los of kidney function and the progression in a continuously ascending gradation of cardiovascular disease.

The leaders of the NKF recognized the part of family physicians in providing medical care for patients with chronic kidney disease (particularly during the early stages when interventions might heavy disease progression) and therefore wanted the guidelines to be practical and accessible to primary care physicians. To these cessations a family physician was invited to be an active participant in the guidelines Work arrange and a member of the K/DOQI Advisory Board, which supervises all guidelines developed under its auspices. At at hand there are only about 5000 nephrologists in the United States. With the contriveed increase in the number of patients diagnosed with chronic kidney disease (especially as defined according to the NKF guidelines (7,8)), a potent partnership with family physicians and general internists will be necessary.

The first project of this article is to disseminate the simple definition and the five-stage classification scheme of chronic kidney disease that were disentangleed through an evidence-based process and justified with existing literature. The inferior purpose is to describe the six guidelines with the greatest in number immediate relevance to family physicians. Guidelines forward evaluation, treatment, and risk factors are reviewed in part I of this two-part article. Part II (9) reviews guidelines onward estimation of glomerular filtration rate, assessment of proteinuria, and use of markers of chronic kidney disease other than proteinuria.

Background

The NKF Work collection defined two principal outcomes of chronic kidney disease: progressive los of kidney function and progress to maturity of complications, particularly cardiovascular disease.

Progressive los of kidney function throughout time in most patients with chronic kidney disease is a well-known consequence Because of the older age at first brunt for many forms of kidney disease and the moderate rate of decline in kidney function, decreased kidney function is far more universal than kidney failure, for which replacement therapy (dialysis or transplantation) becomes necessary.

Decreased kidney function is associated with complications in virtually all organ rules Therapeutic interventions in the earlier stages may obstruct or ameliorate some of these complications, as well as inactive progression to kidney failure. Cardiovascular disease is considered an result of chronic kidney disease for several reasons. First, cardiovascular marked occurrences are more common than kidney failure in patients with chronic kidney disease. In addition, chronic kidney disease appears to be a risk factor for cardiovascular disease.

Cardiovascular disease in patients with chronic kidney disease is treatable, as well as potentially preventable. A 1998 report from the NKF Task Force forward Cardiovascular Disease10 recommended that patients with chronic kidney disease be considered in the "highest risk" cluster for subsequent cardiovascular events, and that in the greatest degree interventions that are effective in the general population should be applied to patients with chronic kidney disease. (1112)

The NKF guidelines (78) are based in succession a systematic literature review using an approach adapted from the common used by the Agency for Healthcare Research and Quality. A uniform format for summarizing toughness of evidence was developed based onward an evaluation of study size, applicability, be deriveds and methodologic quality. Guideline statements were prepared from the analysis of this review. Each rationale statement was graded according to the supporting on a level of evidence (Table 1). (7) Note that the evidence grading regularity differs from the system used in American Family Physician: barely AFP's evidence level C (consensus/expert opinion) compares with the NKF grade O (opinion).