Author Affiliations: Division of Nephrology, University of California, San Francisco, and Nephrology Section, San Francisco VA Medical Center, San Francisco, California.
According to current guidelines, the presence of chronic kidney disease (CKD) should be established, based on presence of kidney damage and level of kidney function (glomerular filtration rate [GFR]), regardless of diagnosis.1 In general, patients with a GFR lower than 30 mL/min/1.73 m2 (stage 4 CKD) should be referred to nephrologists.1 Ideal management of patients with CKD should include treatment to slow progression of kidney disease; prevent cardiovascular events; address the complications of CKD, such as anemia, disordered mineral and bone metabolism (CKD-MBD), and protein-energy wasting; and prepare for end-stage renal disease (ESRD). Internists are well versed in the management of hypertension and hyperlipidemia in patients with CKD, targeting a blood pressure lower than 130/80 mm Hg, preferentially using angiotensin converting–enzyme (ACE) inhibitors or angiotensin receptor antagonists (ARBs) among patients with diabetes or other kidney diseases associated with heavy proteinuria, and considering patients with CKD to be in the highest risk category for cardiovascular disease.1
Johansen KL. Is Predialysis Nephrology Care Worthwhile?. Arch Intern Med. 2011;171(15):1317-1318. doi:10.1001/archinternmed.2011.362