Designed and created by Guideline Central in participation with the Veterans Health Administration / Department of Defense
Management of Chronic Kidney Disease
Publication Date: April 1, 2020
Last Updated: March 3, 2023
Objective
Objective
This patient summary means to discuss key recommendations from the Department of Veterans Affairs, the Department of Defense, for chronic kidney disease. This patient summary is limited to adults 18 years of age and older and should not be used as a reference for children.
Overview
Overview
- Chronic kidney disease is a progressive decline in kidney function, eventually leading to kidney failure.
- We will use the abbreviation CKD throughout this summary to refer to chronic kidney disease.
- There are many causes for chronic kidney disease, among them are:
- Diabetes
- High blood pressure
- Heart disease
- Blood vessel disease
- Chronic inflammatory diseases like lupus
- Infections
- Primary kidney diseases like glomerulonephritis
- Symptoms are mostly from the underlying diseases; people with CKD just don’t feel well.
- This patient summary focuses on the treatment of all stages of chronic kidney disease.
Diagnosis
Diagnosis
- Diagnosis of CKD is made incidentally during checkups or management of underlying conditions.
- Screening of kidney dysfunction is made by routine lab testing using blood and urine.
- Sometimes a kidney biopsy is needed for a specific cause.
Treatment
Treatment
- Early aggressive treatment of any underlying diseases like diabetes or high blood pressure is the best way to preserve kidney function.
- Initial treatment of mild kidney dysfunction can delay worsening.
- Your personal doctor may refer you to nutritionists/dieticians for a kidney-friendly diet.
- Closer management of other diseases will help.
- At some point, you will be referred to a nephrologist for a complete evaluation and a treatment plan uniquely tailored to your medical situation.
- The plan will include a special diet.
- The VA suggests a drug called metformin for type 2 diabetes.
- Another suggested diabetes drug class to slow the progression of CKD is sodium-glucose co-transporter 2 inhibitors (SGLT2i),
- Another add-on option is the glucagon-like peptide-1 receptor agonists (GLP-1 RAs) liraglutide or dulaglutide.
- Intensive blood pressure management is required.
- Management of iron deficiency, anemia, and special nutritional and fluid needs is also needed.
- Ultimately dialysis with an artificial kidney machine will be required.
- For an artificial kidney machine, you will need durable access to your blood circulation, usually with a catheter placed through your skin into a vein.
- This requires specialized care and your knowledge of how to deal with it at home.
- Sometimes dialysis can be done at home by flushing a special solution through your abdomen, this time with a catheter placed there and instructions for you to do most of the work after you have been thoroughly trained and always with close monitoring.
- For an artificial kidney machine, you will need durable access to your blood circulation, usually with a catheter placed through your skin into a vein.
- For those who are able to undergo the procedure and follow-up and can find a compatible donor, a kidney transplant is the curative treatment.
Abbreviations
- CKD: Chronic Kidney Disease
- GLP-1 RAs: Glucagon-like Peptide-1 Receptor Agonists
- SGLT2i: Sodium-glucose Cotransporter-2 Inhibitors
- VA: Veterans Administration
Source Citation
https://www.healthquality.va.gov/guidelines/CD/ckd/index.asp
Disclaimer
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.