Chronic kidney disease in primary care practice

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Abstract

Chronic kidney disease (CKD) often progresses to the end stage with complete loss of kidneys function, requiring dialysis or renal transplantation. At the same time, the mortality of CKD patients rapidly increases, primarily from cardiovascular causes, as the glomerular filtration rate decreases and protein (albumin) excretion in the urine gets more intensive. The progression of the disease can be slowed down by the use of a set of renoprotective therapy measures, including lifestyle changes, diet, and special drug classes use. Lecture presents the process of making medical decisions concerning CKD treatment with an emphasis at them aspects relevant to primary care physicians.

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About the authors

Evgeny M. Shilov

N.V. Sklifosovsky Institute of Clinical Medicine of I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University)

Author for correspondence.
Email: emshilov@gmail.com

MD, Professor, Professor of the Department of Internal, Occupational Diseases and Rheumatology

Russian Federation, Moscow

Olga N. Sigitova

Kazan State Medical University of the Ministry of Healthcare of Russia; Kazan State Medical Academy – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia

Email: osigit@rambler.ru
ORCID iD: 0000-0001-8983-245X

MD, Professor of the Department of Polyclinic Therapy and General Medical Practice, Kazan State Medical University of the Ministry of Healthcare of Russia, Professor of the Department of Urology of Kazan State Medical Academy – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia

Russian Federation, Kazan; Kazan

References

  1. Kidney Diseases Improving Global Outcomes. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013; 3(1): 1–150.
  2. Клинические рекомендации. Хроническая болезнь почек. Союз педиатров России, Творческое объединение детских нефрологов, Российское трансплантологическое общество. Рубрикатор клинических рекомендаций Минздрава России. 2022. ID: 713. Доступ: https://cr.minzdrav.gov.ru/schema/713_1 (дата обращения – 01.04.2023). [Clinical guidelines. Chronic kidney disease. Union of Pediatricians of Russia, Creative Association of Pediatric Nephrologists, Russian Transplant Society. Rubricator of clinical guidelines of the Ministry of Healthcare of Russia. 2020. ID: 713. URL: https://cr.minzdrav.gov.ru/schema/713_1 (date of access – 01.04.2023) (In Russ.)].
  3. Levey A.S., Becker C., Inker L.A. Glomerular filtration rate and albuminuria for detection and staging of acute and chronic kidney disease in adults: A systematic review. JAMA. 2015; 313(8): 837–46. https://dx.doi.org/10.1001/jama.2015.0602.
  4. Glassock R.J., Warnock D.J., Delanaye P. The global burden of chronic kidney disease: Estimates, variability and pitfalls. Nat Rev Nephrol. 2017; 13(2): 104–11. https://dx.doi.org/10.1038/nrneph.2016.163.
  5. Levey A.S., Eckardt K.U., Dorman N.M. et al. Nomenclature for kidney function and disease-executive summary and glossary from a Kidney Disease: Improving Global Outcomes (KDIGO) consensus conference. Eur Heart J. 2020; 41(48): 4592–98. https://dx.doi.org/10.1093/eurheartj/ehaa650.
  6. Shlipak M.G., Tummalapalli S.L., Boulware L.E. et al. The case for early identification and intervention of chronic kidney disease: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) controversies conference. Kidney Int. 2021; 99(1): 34–47. https://dx.doi.org/10.1016/j.kint.2020.10.012.
  7. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int. 2021; 99(3S): S1–S87. https://dx.doi.org/10.1016/j.kint.2020.11.003.
  8. McGuire D.K., Shih W.J., Cosentino F. et al. Association of SGLT2 inhibitors with cardiovascular and kidney outcomes in patients with type 2 diabetes. A meta-analysis. JAMA Cardiology. 2021; 6(2): 148–58. https://dx.doi.org/10.1001/jamacardio.2020.4511.
  9. Perkovic V., Jardine M.J., Neal B. et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019; 380(24): 2295–306. https://dx.doi.org/10.1056/NEJMoa1811744.
  10. Heerspink H.J.L., Stefansson B.Y., Correa-Rotter R. et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020; 383(15): 1436–46. https://dx.doi.org/10.1056/NEJMOA2024816.
  11. Kristensen S.L., Roth R., Jhund P.S. et al. Cardiovascular, mortality and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: A systematic review and meta-analysis of cardiovascular outcomes trials. Lancet Diabetes Endocrinol. 2019; 7(10): 776–85. https://dx.doi.org/10.1016/S2213-8587(19)30249-9.
  12. Дедов И.И., Шестакова М.В., Майоров А.Ю. с соавт. «Алгоритмы специализированной медицинской помощи больным сахарным диабетом». Под ред. И.И. Дедова, М.В. Шестаковой, А.Ю. Майорова. 10-й выпуск. Сахарный диабет. 2021; 24(S1): 1–148. [Dedov I.I., Shestakova M.V., Mayorov A.Yu. et al. Standards of specialized diabetes care. Edited by Dedov I.I., Shestakova M.V., Mayorov A.Yu. 10th edition. Sakharnyy diabet = Diabetes mellitus. 2021; 24(S1): 1–148 (In Russ.)]. https://dx.doi.org/10.14341/DM12802. EDN: ISOZCM.
  13. Bakris G.L., Agarwal R., Anker S. et al.; FIDELIO-DKD Investigators. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N Engl J Med. 2020; 383(23): 2219–29. https://dx.doi.org/10.1056/NEJMOA2025845.
  14. Williams B., Mancia G., Spiering W. et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39(33): 3021–104. https://dx.doi.org/10.1093/eurheartj/ehy339.
  15. Guideline for the pharmacological treatment of hypertension in adults. Geneva: World Health Organization. 2021. ISBN: 978-92-4-003398-6 (electronic version), 978-92-4-003397-9 (print version).
  16. American Diabetes Association Professional Practice Committee. 11. Chronic kidney disease and risk management: Standards of medical care in diabetes-2022. Diabetes Care. 2022; 45(Suppl 1): S175–S184. https://dx.doi.org/10.2337/dc22-S011.
  17. Hemmelgarn B.R., Manns B.J., Tonelli M.; Interdisciplinary Chronic Disease Collaboration. A decade after the KDOQI CKD guidelines: A perspective from Canada. Am J Kidney Dis. 2012; 60(5): 723–24. https://dx.doi.org/10.1053/j.ajkd.2012.08.026.
  18. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease – mineral and bone disorder (CKD-MBD). Kidney Inter Suppl (2011). 2017; 7(1): 1–59. https://dx.doi.org/10.1016/j.kisu.2017.04.001.
  19. Zoccali C., Ruggenenti P., Pernaet A. et al. Phosphate may promote CKD progression and attenuate renoprotective effect of ACE inhibition. J Am Soc Nephrol. 2011; 22 (10): 1923–30. https://dx.doi.org/10.1681/ASN.2011020175.
  20. Kidney Diseases Improving Global Outcomes. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Inter Suppl. 2012; 2(4): 279–335.
  21. Wang B., Yin Q., Han Y.C., et al. Effect of hypoxia-inducible factor-prolyl hydroxylase inhibitors on anemia in patients with CKD: A meta-analysis of randomized controlled trials including 2804 patients. Ren Fail. 2020; 42 (1): 912–25. https://dx.doi.org/10.1080/0886022X.2020.1811121.
  22. Kidney Diseases Improving Global Outcomes. KDIGO clinical practice guideline or lipid management in chronic kidney disease. Kidney Inter Suppl. 2013; 3(3): 259–305.

Supplementary files

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2. Fig. 1. Classification of chronic kidney disease (color-coded risk of progression of chronic kidney disease and cardiovascular death) [1]

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3. Fig. 2. Principles of chronic kidney disease treatment

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