The Journal of the Arkansas Medical Society Issue 3 Vol 115 | Page 13

AFMC: A CLOSER LOOK AT QUALIT Y
CONTROLLING CKD PROGRESSION
The first step is to identify high-risk
patients and attempt to reduce the
modifiable risk factors such as smok-
ing or obesity. Treat the underlying
etiology of CKD by controlling diabe-
tes, hypertension and using antipro-
teinuric medications. Nephrology
referral is critical. Referring patients to
dieticians and CKD education pro-
grams also helps to slow progression. 6
If unable to control progression,
patients must understand their
remaining options: dialysis, kidney
transplant and palliative care.
Dialysis can be provided via differ-
ent paths:
• In-Center Hemodialysis (IHD), the
most common and expensive,
involves three- to four-hour
treatments, three times weekly.
• Home Dialysis (HOD) provides
patient autonomy, diet
liberalization, ability to continue
employment and the convenience
of home. HOD provides better
clinical outcomes and patient
satisfaction and saves about
$19,000 per patient, per year.
It most closely mimics the
body’s natural physiological
renal clearance, with more
frequent and longer dialysis.
• HOD can be administered via
peritoneal dialysis (PD), using the
peritoneal membrane as a filter;
no blood or needles are involved.
• Home hemodialysis (HHD)
usually provides shorter but
more frequent dialysis using
patient-friendly machines.
Kidney transplantation can be
performed with a living or deceased
donor. Outside of patients with
cirrhosis, most individuals with eGFRs
below 20 mL/min/1.73m2 are eligible
for possible transplantation. Most
transplants occur after patients are on
dialysis. Preemptive kidney transplant
can occur before the patient needs
dialysis. Early referral for transplant
evaluation is important.
Palliative care discussions can
be part of the patient and family
discussion about treatment goals. For
some patients, the burden of chronic
disease or frequent hospitalizations
prevents an acceptable quality of
life. Renal failure compounds this
situation and for some patients,
dialysis does not increase quality of
life or longevity.
Awareness of CKD is low. In a large
managed-care cohort of CKD patients,
stages 3-5, physician documenta-
tion was 14.4 percent. 7 In a survey of
high-risk, urban, African-American
adults, less than 3 percent named
kidney disease as an important health
problem, compared to 61 percent and
55 percent naming hypertension and
diabetes, respectively. 8,9 Even among
patients with stages 4-5 CKD, less
than half were aware of their disease.
IMPROVING CKD-PATIENT CARE:
1. At the primary care level, recognize
high-risk patients, assess GFR using
urine dipstick for proteinuria/
albuminuria and have the lab
calculate eGFR.
2. Involve nephrology care as soon as
appropriate.
3. Optimize care using CKD
management guidelines, produced
and freely accessible from KDIGO.
4. Know the options for CKD control
and ESRS management.
The UAMS Division of Nephrol-
ogy and Arkansas Department of
Health’s Chronic Disease Branch
are working to increase CKD aware-
ness and support CKD education.
The Arkansas State Chronic Kidney
Disease Advisory Committee (ARCK-
DAC) is a collaboration of multiple
governmental agencies, renal groups,
nonprofits and patient advocates.
Its goals are to improve awareness,
detection and education through
community engagement. The AFMC
has ongoing initiatives for similar
goals, including grassroots health
education for CKD patients. s
The authors practice in the Division
of Nephrology, Deptment of Internal
Medicine, UAMS.
REFERENCES
1. Centers for Disease Control and
Prevention. Chronic Kidney Disease
Surveillance System Website. http://
www.cdc.gov/ckd. Accessed 6-29-18.
2. Kazancioğlu R. Risk factors for chronic
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371. doi:10.1038/kisup.2013.79.
3. Kidney Disease: Improving Global
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KDIGO 2012 Clinical Practice Guideline
for the Evaluation and Management
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(2013) Renal function can improved
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8(12)e81835.doi: 10.1371/journal.
pone.0081835
7. Guessous I, McClellan W, Vupputuri S,
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8. Waterman AD, Browne T, Waterman
BM, et al. Attitudes and behaviors of
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9. National Health and Nutrition Exam-
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