Helping Your Patients Thrive with Kidney Disease

For your patients at risk of chronic kidney disease (CKD) or who have already been diagnosed, early action is the best way to help people take control of their health and start living healthier. Early testing and diagnosis are especially important for patients who have a condition linked to kidney disease, or have a family history of CKD. An early referral to a nephrologist—preferably by stage 3b or when a patient’s GFR is below 44—allows the nephrologist to further diagnose your patients’ kidney health, help your patients learn more about managing their kidney health, and offer recommendations that may help slow the progression of kidney disease.

People with the following conditions have a higher risk for developing chronic kidney disease (CKD):

  • Diabetes—causing 44% of kidney disease cases
  • High blood pressure-causing 29% of kidney disease cases
  • Cardiovascular disease-causing and developing as a result of CKD

Testing for kidney disease early—and knowing the signs

For at-risk patients, an early diagnosis and immediate action to protect kidney health can make it possible to slow kidney disease progression in many instances. Talking to your patients about their estimated glomerular filtration rate (eGFR), and what that means in terms of kidney health and their CKD stage, can help patients understand their diagnosis and the importance of following medical guidance.
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KNOW WHAT TO LOOK FOR:

  • Proteinuria (protein in the urine)
  • Hematuria (blood in the urine)
  • Elevated creatinine or decreased GFR
  • Difficulty controlling hypertension
  • Kidney stones

When to refer your patients to kidney disease experts

While every patient has unique needs, referring your patients to a renal dietitian and a nephrologist by stage 3 CKD can help ensure better health outcomes. While eGFR can be a helpful indicator of when to refer patients to a nephrologist, proteinuria, hematuria, and other signs of CKD may also contribute to the decision. You’ll still be managing your patients’ overall health, even while partnering with a nephrologist. Together, you can help patients take control of their health and live well with kidney disease.

According to the National Center for Biotechnology Information (NCBI), timely referral to outpatient nephrology care not only slows progression, it also reduces CKD treatment costs. Diet can also have a big impact on kidney health. Referring to a renal dietitian early can help your patients stay their healthiest by making the best food choices for their CKD diagnosis and overall health.

BEST TIME TO REFER

 KIDNEY EXPERT CKD STAGE
Renal Dietitian By stage 3a — eGFR of 59 or lower
Nephrologist By stage 3b — eGFR of 44 or lower

CKD Stage 4 is the ideal time to discuss treatment options

Stage 4 CKD (eGFR of 15-29) is the ideal time to prepare your patients for possible kidney failure treatment options, including transplant, home dialysis, and access placement, as optimal dialysis starts can take time to plan for. Your patients should already be seeing a nephrologist at this point in their journey. A nephrologist will help your patients prepare and plan for treatment in order to limit hospitalizations and emergency room visits due to unexpected kidney failure. They can also help your patients understand their treatment options so your patients can make the best decisions to fit their lifestyle.


By stage 5 CKD (eGFR of <15), your patients should have a treatment option selected and an access placed (as needed). So, if or when the time comes, your patients will be fully prepared to start the treatment that is best for them.


The following resources can support your conversations with patients so you can help educate them about their treatment options:

MORE KNOWLEDGE MEANS BETTER RESULTS

Studies show that patient education is associated with better patient outcomes—and is supported by international guidelines and organizations as a critical component of care.1

Source: 1. Narva A, Norton J, Boulware LE. Educating Patients about CKD: The Path to Self-Management and Patient-Centered Care; Clinical Journal of American Society of Nephrology. November 2015.

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KNOW YOUR PATIENTS’ GFR

Estimated glomerular filtration rate (eGFR) is a measurement that indicates how well a person's kidneys are working. Knowing their eGFR can help you determine which CKD stage they are in-and if they should be referred to a nephrologist. 
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SLOWING THE PROGRESSION OF CKD

Slowing the progression of chronic kidney disease (CKD) may be even more possible thanks to potentially ground-breaking drugs called "SGLT2 lnhibitors"­previously designed to treat diabetes. Hear more from Dr. Robert Kossman on the FMCNA Field Notes podcast. 
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