ChroniC Kidney disease- Pre-dialysis ManageMent: the aCtion Plan

Chronic Kidney Disease (CKD) is becoming one of the major public health problems. Incidence of CKD is doubled in last fifteen years. CKD is under diagnosed and undertreated. The treatment cost is high and outcome is poor. In India, only 10% of patients with end stage renal disease (ESRD) have access to renal replacement therapy. Therefore action plan should be early detection of CKD by screening high risk patients with hypertension, diabetes, Obesity, Nephrotic syndrome and stone diseases. Once the diagnosis of CKD is established, determine the underlying cause, rule out reversible causes like obstruction, dehydration, infection and malignant hypertension. Stage the CKD according to estimated GFR from serum creatinine. During stage 1 and 2, the focus should be on treatment of cause, comorbidities, addressing reduction of cardiovascular risk factors and instituting measures to slow the progression of CKD. During these early stages aggressive blood pressure control, diabetes control and reduction of proteinuria are mainstay of therapy. In stage 3 in addition to continuing measure described the focus shift to evaluating and treating complications of CKD such as anemia, malnutrition, mineral bone disease, hypertension, acidosis, volume overload and overall health. By stage 4 preparation for renal replacement therapy (RRT) (dialysis& transplant), creation of vascular access and patient education should begin. When stage 5 is reached or symptoms of uremic syndrome ensue renal replacement therapy is started. Stage 5 –stage of Kidney failure need optimized Predialysis care to improve dialysis and transplantation outcome. Early referral to nephrologist in stage 4 or one year in advance of requirement of RRT is associated with better outcome.