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• W2893216961 abstract "FigureChronic kidney disease (CKD) has been called a silent epidemic because as many as 90% of people with mild CKD and 94% of people with moderate-to-severe CKD are unaware they have the condition.1 An estimated 15% of the US population has CKD, a number that is expected to increase with the rise in the prevalence of risk factors, including diabetes, hypertension, and obesity.2,3 A recent model predicting the future burden of CKD in the United States estimates lifetime incidence of CKD of 54% for adults ages 30 to 49 years, 52% for those ages 50 to 64 years, and 42% for those age 65 years and older.3 Concurrent with the increase in CKD is a shortage of nephrology specialists in the United States and globally.4 The US nephrologist workforce is estimated at 8,000 adult and 500 pediatric nephrologists, or about one nephrologist for every 2,850 patients with moderate CKD.5,6 Because CKD often is found incidentally on routine laboratory tests in primary care, most patients at risk for CKD or who have CKD receive care in primary care settings.7 On page 17 of this issue, Kim Zuber, PA-C, and Jane Davis, DNP, describe “The ABCs of chronic kidney disease.” The article focuses on the diagnosis and management of CKD in the primary care setting, where most patients with CKD receive care. But because the authors emphasize the need for early identification of CKD and risk-factor mitigation to reduce disease progression, the article contains practice pearls for PAs in all specialties. Since the publication of the last Kidney Disease Improving Global Outcomes (KDIGO) guideline in 2012, updated guidelines and recommendations for the management of diabetes, hypertension, hyperlipidemia, obesity, and tobacco use have been published.8-13 Using a case-exemplar format, the authors incorporate these newer guidelines into the “care and feeding” of patients with CKD. Two important aspects of improving care and outcomes for patients with CKD are not addressed in the article: quality improvement (QI) measures and multidisciplinary team care. QI has been shown to improve identification of CKD; management of BP and anemia; care coordination; adherence to treatment guidelines; and in one study, small but significant improvements in glomerular filtration rate.14-17 QI involves specific strategies, including creating a team, setting goals, establishing measures, identifying strategies for change, testing and implementing changes, and disseminating results.18 QI can be implemented with clinical decision support strategies such as risk assessment tools, health maintenance protocols, flow charts, and a patient registry.19 The authors refer readers with validated clinical decision support tools and patient education resources that can be used to support QI projects. QI activities also provide an opportunity for performance improvement CME (PI-CME). The American Academy of Nephrology PAs has developed Kidneys in a Box, an evidence-based performance improvement project that can be used by healthcare providers to improve management of patients with diabetes, the leading cause of CKD.20 CKD is a consequence of multisystem disease and environmental toxins.21,22 Of these causes, diabetes is the most common cause worldwide.21 Additionally, CKD accelerates vascular disease and premature aging, with clinical manifestations in virtually every body system.22 Care of patients with this complex, multisystem disease is managed optimally by interprofessional teams. Studies support the efficacy of interprofessional teams in reducing morbidity and mortality in patients with CKD and end-stage renal disease.23-28 Given the prevalence of CKD, all PAs working in primary care will care for patients at risk for or with some degree of renal impairment. Increasing our awareness of this silent epidemic can improve outcomes for our patients. Though the number of PAs working in nephrology is still relatively low, the growing demand for interprofessional teams to meet the needs of the expanding population with CKD provides an opportunity for PAs interested in this field.29-31" @default.
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• W2893216961 date "2018-10-01" @default.
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• W2893216961 title "Caring for patients with chronic kidney disease" @default.
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• W2893216961 doi "https://doi.org/10.1097/01.jaa.0000545076.32215.78" @default.
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