Assessment and Management of the Person with Chronic Kidney Disease
Staging and monitoring
Understand CKD definition (abnormal kidney structure or function persisting beyond three months) and staging by GFR category and albuminuria category, because risk and referral depend on both. Track trends rather than single values: creatinine, estimated GFR, urine albumin-to-creatinine ratio, potassium, bicarbonate, calcium, phosphate, parathyroid hormone, hemoglobin, and iron studies. Know when nephrology referral is indicated and why early referral improves preparation for kidney replacement therapy.
Managing complications
Slow progression with blood pressure control, renin-angiotensin system blockade when indicated, glycemic management, avoidance of nephrotoxins, and attention to diet. Manage anemia (iron repletion before or with erythropoiesis-stimulating agents), metabolic acidosis, mineral and bone disorder (phosphate binders, active vitamin D, calcimimetics), hyperkalemia, and volume status. Address cardiovascular risk, which is the leading cause of death. Review medication dosing for reduced clearance and avoid nonsteroidal anti-inflammatory drugs and inappropriate contrast exposure.
Traps in questions
Do not equate a stable elevated creatinine with an emergency; look for uremic complications, refractory hyperkalemia, acidosis, volume overload, or pericarditis that demand urgent dialysis. Distinguish CKD from acute kidney injury by history and trend. Do not apply dialysis clearance assumptions to residual kidney function. Watch for questions that describe a patient with CKD and a new drug where the safe answer is dose adjustment, not discontinuation.
Worked example and rule of thumb
A patient with GFR category G4, potassium 5.9 mmol/L, and bicarbonate 18 mmol/L needs both potassium management and acidosis treatment; sodium bicarbonate may improve acidosis and help potassium shift. Rule of thumb: for every new finding in CKD, ask whether it is a progression marker, a complication to treat, or a trigger for urgent dialysis planning.