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Chronic kidney disease in general populations and primary care: diagnostic and therapeutic considerations

Taal, Maarten W.

Current Opinion in Nephrology and Hypertension: November 2013 - Volume 22 - Issue 6 - p 593–598
doi: 10.1097/MNH.0b013e328365adf6
DIAGNOSTICS AND TECHNIQUES: Edited by Maarten Taal
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Purpose of review The majority of people with chronic kidney disease (CKD) are managed by primary care physicians and nurses, but much of the initial research on CKD care was based in secondary care. The purpose of this article is to review the important recent studies of CKD in primary care that are starting to provide an evidence base for the strategies to improve the management and outcomes of the unreferred majority of people with CKD.

Recent findings People with CKD in primary care populations differ substantially from those familiar to nephrologists in secondary care by being older, having less reduction in glomerular filtration rate (GFR) and lower prevalence of proteinuria. These differences have important implications for management priorities. Detailed studies have identified widespread deficiencies in the care of patients with CKD in primary care (though these are also reported in secondary care). Interventions that may improve performance include automated reporting of estimated GFR, incentivizing primary care practitioners to achieve therapeutic goals and quality improvement strategies such as audit-based education.

Summary Studies have identified a need for improved management of CKD in primary care as well as methods to achieve this. Future studies should focus on the promotion of self-management through telemedicine and the Internet.

Department of Renal Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, Derbyshire, UK

Correspondence to Maarten W. Taal, Department of Renal Medicine, Royal Derby Hospital, Uttoxeter Road, Derby, Derbyshire, DE22 3NE, UK. Tel: +44 1332 789344; fax: +44 1332 789352; e-mail: maarten.taal1@nhs.net

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins