Estimating kidney function is essential for drug dosing, staging kidney disease, and screening for complications. Creatininebased estimation equations are commonly used for these purposes.
Slowing progression of chronic kidney disease (CKD) is important to reduce risk of end-stage kidney disease, dialysis, cardiovascular complications, and other CKD-related conditions.
Patients with CKD tend to have numerous medications prescribed by multiple practitioners. Medication reconciliation is therefore an essential Medicare Therapy Management (MTM) service component for patients with CKD.
Hospital admissions and readmissions are frequent for patients with CKD. Discharge counseling and educational interventions are important strategies for improving medication use in patients with kidney disease.
INTRODUCTION TO CHRONIC KIDNEY DISEASE
Chronic kidney disease (CKD) is a significant public health concern, affecting nearly 15% of the U.S. population.1 It is progressive and may ultimately lead to end-stage renal disease (ESRD) requiring dialysis or transplantation. The Kidney Disease Outcomes Quality Initiative clinical practice guideline defined CKD in 5 stages, spanning from normal glomerular filtration rate with structural damage (stage 1) to end-stage kidney disease (stage 5).2 The staging was modified by the Kidney Disease Improving Global Outcomes (KDIGO) group to include a notation of cause of CKD, glomerular filtration rate (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 follows: diabetic kidney disease, G3b, A3.
TABLE 16-1Staging of Chronic Kidney Disease ||Download (.pdf) TABLE 16-1 Staging of Chronic Kidney Disease
|GFR Categoryb |
|G1a ||≥90 |
|G2a ||60-89 |
|G3a ||45-59 |
|G3b ||30-44 |
|G4 ||15-29 |
|G5 ||<15 |
|Albuminuria Categoryc |
|A1 ||<30 |
|A2 ||30-300 |
|A3 ||>300 |
CKD is often the result of another underlying 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 and 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 and is the leading cause of death in CKD.1 A high medication burden is typically required to treat the multiple conditions and complications in these patients.5 Once a patient is on dialysis, the average patient takes 12 home medications, putting him/her at especially high risk for medication-related problems (MRPs).5 Therefore, medication management and education are of utmost ...