Practice Guidelines

ACP Releases Guideline on Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease

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Am Fam Physician. 2014 Jul 15;90(2):121-122.

Key Points for Practice

  • Screening for CKD in asymptomatic adults without risk factors is not recommended.

  • Monitoring for proteinuria in adults already taking an ACE inhibitor or an ARB is not indicated.

  • ACE inhibitors and ARBs are the preferred therapies for patients with hypertension and stage 1 to 3 CKD.

  • Statin therapy should be used to manage elevated low-density lipoprotein cholesterol levels in patients with stage 1 to 3 CKD.

From the AFP Editors

Chronic kidney disease (CKD) is commonly defined as abnormalities of the kidney structure or function that are present for longer than three months with implications for health. CKD is typically divided into five stages based on severity as defined by a patient's glomerular filtration rate (GFR). The breakdown of stages in increasing order of severity is as follows:

  • Stage 1: kidney damage with GFR ≥ 90 mL per minute per 1.73 m2

  • Stage 2: kidney damage with GFR of 60 to 89 mL per minute per 1.73 m2

  • Stage 3: GFR of 30 to 59 mL per minute per 1.73 m2

  • Stage 4: GFR of 15 to 29 mL per minute per 1.73 m2

  • Stage 5: GFR < 15 mL per minute per 1.73 m2, or kidney failure treated by dialysis or transplantation

Approximately 22.4 million adults in the United States have stage 1 to 3 CKD, which is considered early-stage CKD. Persons in the early stages are typically asymptomatic. However, these three stages, reduced GFR, and albuminuria are associated with mortality, cardiovascular disease, fractures, bone loss, infections, cognitive impairment, and frailty. Based on a systematic evidence review, this guideline from the American College of Physicians (ACP) presents recommendations on screening, monitoring, and treatment of stage 1 to 3 CKD in adults.

Interventions and Outcomes

The screening and monitoring tests evaluated for the guideline include estimated GFR, microalbuminuria, and proteinuria. The treatments evaluated include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), beta blockers, calcium channel blockers, thiazide diuretics, statins, low-protein diet, intensive control of diabetes mellitus, and intensive multicomponent interventions. The outcomes included all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, chronic heart

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

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