Fast Five Quiz: Chronic Kidney Disease (CKD) Management

A. Brent Alper, Jr, MD, MPH

Disclosures

April 22, 2021

Figure 1. Stage 5 kidney disease. End-stage kidney disease requires 4 hours of dialysis per day, 3-4 times per week, and shortens lifespan by a decade. A kidney transplant is often the best option, but donated kidneys are difficult to obtain. Kidney disease can be prevented by managing its primary risk factors: high blood pressure and diabetes. Both are linked to obesity.

eGFR, calculated by using serum creatinine and/or cystatin C, is a backbone of clinical practice and epidemiologic research, but it lacks precision and accuracy until GFR < 60 mL/min/1.73 m2. Additionally, eGFR may not precisely and accurately represent changes in GFR longitudinally. (There is also growing controversy as to whether race adjustment should remain part of the calculation of eGFR.)

Normochromic normocytic anemia is often seen in CKD. Other underlying causes of anemia should be ruled out.

Measurement of GFR alone may not be sufficient for identifying stage 1 and stage 2 CKD, because GFR may be normal or borderline-normal in patients with early CKD. In such cases, the presence of one or more markers of kidney damage can help to establish the diagnosis. Such markers may include albuminuria, urine sediment abnormalities, electrolyte and other abnormalities due to tubular disorders, histologic abnormalities, structural abnormalities detected by imaging, and/or a history of kidney transplantation.

Although it is frequently seen in patients with CKD, hypertension by itself should not be considered its marker, because elevated blood pressure is also common among people without CKD.

Learn more about CKD medications.

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