Chronic kidney disease (CKD) describes any degree of kidney injury or impaired kidney function that persists for >3 months. CKD is used because it is understandable to clinicians and patients and replaces multiple terms previously used to describe various and frequently over-lapping stages of kidney disease. CKD is a nonspecific term that does not include the cause for the injury and/or impaired kidney function.
There is now compelling evidence of the need for early identification and management of patients with chronic kidney disease (CKD). The evidence also indicates that current care of CKD patients is suboptimal. Accumulating experience indicates that the development of multidisciplinary teams that collaborate to improve patient care should be encouraged. This is based on the observation that patients cared for in a multidisciplinary clinic have higher hemoglobin, albumin, and calcium levels at the start of dialysis, with better survival in the initial months of dialysis than patients treated by nephrologists alone. Numerous studies have also shown a survival advantage for patients referred to nephrologists early (for these studies, early was defined as >1 month before the start of renal replacement therapy [RRT]). Timeliness and appropriateness of referral to nephrologists is important.
The roles of primary care physicians (PCPs) and nephrologists in the care of patients are needed and should be defined. Although differences exist with respect to the recommended time of referral, this is optimally at least 1 year before the anticipated need for RRT in patients with slowly progressive disease.
The goals for CKD care include:
William M. McClellan, MD
Clinical Professor of Medicine
Emory University School of Medicine
Anton C. Schoolwerth, MD
Visiting Professor of Medicine
Hypertension/Nephrology
Darthmouth-Hitchcock Medical Center
Darthmouth Medical School
Todd Gehr, MD
Chairman, Department of Nephrology
Virginia Commonwealth University Health System
Medical College of Virginia Hospitals