![]() It is a common misconception that patients on dialysis have medical issues beyond the scope of a family physician’s practice. What role do I play once my patient starts dialysis? This is especially important in smokers and those older than 40, as these patients often require cystoscopy to rule out occult bladder malignancies. Urology consultation should be considered if initial imaging demonstrates stones or obstruction, the patient has a history of nephrolithiasis, or a patient in the earlier stages of CKD (Stages 1 and 2) has isolated microscopic hematuria, even if the renal ultrasound is normal. If there are questions about the appropriateness of the referral, please contact your local specialist directly. It is important to remember that preparing a patient for renal replacement therapy requires a minimum of 1 year, thus early referral is essential. In addition, specialist referral can be considered if there is difficulty controlling the conditions associated with CKD (e.g., hypertension, anemia). The BC guidelines on CKD provide detailed information for family physicians and expand on the management issues reviewed here.Ĭhronic kidney disease is defined as an eGFR 60 mg/mmol) or an abnormal urinalysis is found on initial screening tests. This requires improving communication between family physicians, nephrologists, and other specialists, identifying CKD at earlier stages, and using a collaborative approach to care for these patients. Given that mortality increases exponentially as GFR declines, we may be able to improve outcomes if we can halt or significantly delay the progression of CKD. In addition, a significant proportion of patients have stable, nonprogressive CKD. The main reason for this discrepancy is the high cardiovascular mortality rate associated with CKD: many patients die before they reach the point where they require dialysis. In contrast, only 2000 or so patients are on dialysis (hemodialysis or peritoneal dialysis), and there is an equally small number who have received kidney transplants. However, if you also include those at highest risk for CKD (people with cardiovascular disease, diabetes, or both), this number could be as high as 400 000. In BC, there are at least 145 000 people with an estimated glomerular filtration rate (eGFR) of less than 60 mL/min, and about 35 000 people whose physicians have actually identified CKD as a medical problem. Once patients are undergoing dialysis or if they choose palliative care, a collaborative approach between the family physician, nephrologist, and renal team (dialysis nurses, dietitians, pharmacists, and social workers) provides the best care for these patients.Ĭhances are you have several patients in your practice with chronic kidney disease (CKD). Regular assessment for cardiovascular disease and conditions related to chronic kidney disease is also essential. The family physician has an important role to play regarding diagnosis, interpretation of kidney function tests, and meeting care objectives (e.g., blood pressure and blood sugar control). However, with the introduction of lab reporting of kidney function, publication of practice guidelines, and continuing medical education opportunities, a shared-care approach involving the family physician and specialists is being fostered in this province, with resulting improved patient outcomes. There is a common misconception that patients with kidney diseases have complex medical problems that can only be managed by specialists. The number of patients with chronic kidney disease in BC is growing.
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