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KEY POINTS

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  • Slowing the progression of chronic kidney disease (CKD) is important to reduce risk of end-stage kidney disease, dialysis, cardiovascular complications, and other conditions related to CKD.

  • Patients with CKD tend to have numerous medications prescribed by multiple practitioners, so medication reconciliation is an essential component of medication therapy management (MTM) for patients with CKD.

  • Hospital admissions and readmissions are frequent for patients with CKD. Post-discharge counseling and educational interventions are essential.

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INTRODUCTION TO CHRONIC KIDNEY DISEASE

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Chronic kidney disease (CKD) affects more than 10% of all Americans.1 It is progressive and can ultimately lead to end-stage kidney disease (ESKD), necessitating dialysis or transplantation. The Kidney Disease Outcomes Quality Initiative clinical practice guideline defines CKD in 5 stages, from normal glomerular filtration rate (GFR) with structural damage (stage 1) to ESKD (stage 5).2 The staging was recently modified in 2013, by the Kidney Disease Improving Global Outcomes (KDIGO) group to include a notation of cause of CKD, GFR, and amount of albuminuria.3 Table 16-1 describes the staging further. For example, a patient who has diabetic kidney disease with a GFR 35 ml/min/1.73m2 and a urinary albumin-to-creatinine ratio of 400 mg/g would be staged as diabetic kidney disease, G3b, A3.

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Table Graphic Jump Location
Table 16-1.Staging of Chronic Kidney Disease3
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Chronic kidney disease is often the result of another condition. Diabetes mellitus is the leading cause of CKD, and hypertension is the second most common cause. Therefore, management of CKD involves treatment of the underlying condition.1 Efforts should be taken to prevent progression of CKD and identify as well as treat complications of kidney disease. As CKD progresses, complications such as anemia, mineral and bone disorders, hypertension, hyperkalemia, edema, and acid-base disorders may develop.4 Cardiovascular disease is also highly prevalent; indeed, it is the leading cause of death in patients with CKD.1 A high medication burden is typically required to treat the multiple conditions and complications in these patients.5 Once patients are on dialysis, they are prescribed an average of 12 home medications, putting them at especially high risk for medication-related problems (MRPs).5

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Because of the high frequency of MRPs, CKD patients are an ideal population for MTM services. Additionally, patients with ESKD qualify for Medicare benefits regardless of age,6 so a large proportion of them will receive benefits from a Medicare Part D plan.1...

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