Chronic Kidney Disease (CKD) – Improving screening & identification of CKD for adult patients in Ontario
The prevalence of chronic kidney disease is similar to diabetes1 yet there has been little quality improvement attention.2 Diabetes is the leading cause of CKD in Canada.3 50% of Ontarians with diabetes are estimated to have CKD. People with CKD are considered to be at high risk of vascular events.3 In Ontario, approximately 12,000 people have CKD and an additional 10,500 require dialysis.4
Evidence indicates that if existing screening and treatment clinical management guidelines are applied in the primary care sector, the majority of CKD impacts would be prevented, delayed, or ameliorated.5
- Identification requires screen for proteinuria and assessment of renal function
- All patients with CKD should be considered as high risk for cardiovascular disease and treated to reduce these risks
- Progression of CKD can be slowed by intensive glycemic control, optimization of blood pressure and the use of medications that disrupt the RAAS
Early identification of CKD and appropriate management including referral to a nephrologist by a primary care provider correlates with a 12-20% reduction in mortality for patient with diabetes.6 Most patients with CKD will die of cardiovascular events.7 Therefore, an important focus of care for patients with chronic kidney disease includes management of cardiovascular risk factors.7
- Lipsocombe, L.C., & Huse, J. E. (2007). Trends in diabetes prevalence, incidence, and mortality in Ontario, Canada (1995-2005): A population-based study. Lancet, 369, 750-756.
- Tu, K., Bevan, L., Hunter, K., Rogers, J., Young, J., & Nesrallah, G. (2017). Quality indicators for the detection and management of chronic kidney disease in primary care in Canada derived from a modified Delphi panel approach. CMAJ OPEN, 5(1). Retrieved from http://cmajopen.ca/content/5/1/E74.full.pdf+html
- Diabetes Canada. (2008). Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada, Chronic Kidney Disease in Diabetes, Volume 32, Supplement 1, pp. S126-S134. Retrieved from http://www.diabetes,ca/cpj2008/cpg-2008.pdf (Resource missing)
- Ontario Renal Network. Impact on Ontario’s healthcare system. Retrieved from http://www.renalnetwork.on.ca/info_for_patients/impact_of_ckd/#.WQbRUPnytPY
- Snively, C.S., & Gutierrez, C. (2004). Chronic kidney disease: Prevalence and treatment of common complications. American Family Physician, 70(10), 1921-1924.
- The Canadian Society of Nephrology. (2007). Detection, monitoring and referral of chronic kidney disease, CSN Implementation Committee Retrieved from http://www/csnscn.ca/english/professionalpracticeguidelines/implemenationcommittee(Resource missing)
- Levin, A., Hemmelgarn, B., Culletan, B., Tobe, S., McFarlane, P., Ruzicka, M., et al for the Cadian Society of Nephrology. (2008). Guidelines for the management of chronic kidney disease. CMAJ, 179(11), 1154-1162.
Vascular Health Primary Care Work Group
Last Updated: April 30, 2017