CKD is common, especially when patients are diagnosed with Type 2 Diabetes; CKD causes damage to the kidneys and heart without symptoms.
If diagnosed early, interventions can preserve kidney health and kidney function.
uACR and eGFR are both required to diagnose CKD, rising uACR can be detected earlier than decreasing eGFR, thus allowing for early intervention.
Diabetes is a primary risk factor for CKD
Screening for CKD with both eGRF and uACR when a patient has Type 2 Diabetes is imperative
Glycemic control decreases CKD risk
Primary care providers also play a pivotal role in managing diabetes to prevent the progression of CKD in their patients. Diabetes is a leading cause of CKD, and uncontrolled blood glucose levels can have a profound impact on kidney health. Evidence from clinical studies highlights the significance of diabetes control in reducing the risk of CKD progression. The landmark Diabetes Control and Complications Trial (DCCT) and its follow-up study, the Epidemiology of Diabetes Interventions and Complications (EDIC) trial, demonstrated that intensive glycemic control in individuals with insulin-dependent diabetes significantly reduced the development and progression of albuminuria, early indicators of kidney damage5. Similarly, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial revealed that intensive glycemic control in type 2 diabetes patients led to a modest reduction in albuminuria, indicating a potential benefit in preserving kidney function6.
As primary care providers, it is crucial to emphasize the importance of diabetes control through lifestyle modifications, medication adherence, blood pressure management, lipid management, and regular monitoring of blood glucose levels. In addition to maintaining optimal glycemic control, maintaining blood pressure control, managing lipids, and utilizing agents with a cardiorenal benefit not only help prevent or delay the onset of CKD but also reduces the risk of other diabetes-related complications, such as cardiovascular disease and retinopathy. This four-pillar approach to managing diabetes is recommended in the 2022 Standards of Care in Diabetes to reduce diabetes-related complications7. Collaborative efforts with patients to achieve and maintain target glycemic levels, typically an A1C of ≤ 7%, can significantly improve long-term outcomes and quality of life while mitigating the burden of CKD in individuals with diabetes.
Blood Pressure Control (120/80) slows CKD Progression
Elevated blood pressure contributes to renal damage
Cardiovascular risk and cardiovascular events are increased with CKD
As primary care providers, the importance of blood pressure control in slowing the progression of chronic kidney disease (CKD) and reducing cardiovascular risk cannot be overstated. Hypertension is one of the leading causes and risk factors for CKD progression, as elevated blood pressure contributes to renal damage and a decline in kidney function over time. Several studies have highlighted the critical role of blood pressure management in slowing the progression of CKD and reducing CV risk.
Furthermore, a landmark randomized clinical trial, the Systolic Blood Pressure Intervention Trial8 investigated the impact of intensive versus standard blood pressure control on renal outcomes. The study found that targeting a systolic blood pressure of less than 120 mmHg, as opposed to the standard target of less than 140 mmHg, resulted in a 27% reduction in the risk of death. These findings reinforce the critical importance of aggressive blood pressure management in CKD patients to preserve renal function and decrease the risk of cardiovascular event. As primary care providers, prioritizing blood pressure control through a combination of lifestyle modifications, appropriate antihypertensive medications such ace ACE-inhibitors and angiotensin receptor blockers as well as regular monitoring are paramount in mitigating the devastating effects of CKD on kidney health and overall patient outcomes.
CKD is not a low impact chronic disease and can lead to complications
Prognosis depends on treatment intervention
Early intervention improves health outcomes, there are many kidney protecting interventions
Even though CKD does not always appear to be causing problems and patients do not always have symptoms that impact their lives, CKD is a progressive, chronic disease that will advance without treatment. Prognosis is dependent on treatment intervention, which is dependent on screening. As clinicians, we can reduce or delay the development of end-stage renal disease and dialysis, reduce cardiovascular events associated with CKD, and overall slow the progression of CKD. All of these interventions have a significant improvement in the patient’s quality of life.9
