Chronic Kidney Disease in Primary Care

Duaine D. Murphree, MD; Sarah M. Thelen, MD

Disclosures

J Am Board Fam Med. 2010;23(4):542-550. 

In This Article

Patient Education

Patients need to be educated about their disease process so that their expectations are appropriate and they are active participants in their care. Patients need to be aware that over-the-counter medications (such as NSAIDs) are harmful to their kidney functioning and must be avoided. In addition, patients should be encouraged to bring all of their over-the-counter medications to their appointments for review because numerous herbal and weight-loss medications can also be nephrotoxic.

Patients with stage 4 chronic kidney disease need to be educated about the options of transplantation, hemodialysis, and peritoneal dialysis. These discussions should not be delayed until the point of impending dialysis and are best accomplished in conjunction with a nephrologist. It is known that morbidity and mortality are significantly improved when patients do not have to use temporary access for dialysis.[22,23] A fistula should be placed approximately 6 months before anticipated need for dialysis to allow for maturation as well as any revisions that may be necessary. A graft, however, can be placed approximately 3 to 6 weeks before predicted time of need for dialysis. A peritoneal catheter should be placed 2 weeks before its anticipated time of need. Patients with stage 4 chronic kidney disease should also be counseled about not allowing blood draws or intravenous access, particularly subclavian lines or peripherally inserted central catheter lines in their nondominant upper extremity or other sites as dictated by imaging studies because the complications of these procedures may preclude the use of the involved extremity for future dialysis access.

The family physician needs to be ready to educate chronic kidney disease patients about these topics and provide preventive care and ongoing care to this patient population. Although referral to a nephrologist is always an option, family physicians should feel comfortable with making the initial diagnosis of chronic kidney disease and with providing appropriate initial and ongoing care to these patients.

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