Chronic Kidney Disease: the Canary in the Coal Mine

Chronic kidney disease is a common condition that is costly to manage. Most of the costs are linked with advanced kidney disease and the associated cardiovascular disease. Fortunately, there are now several treatments that can not only slow the progression of chronic kidney disease but also reduce the burden of cardiovascular morbidity and mortality. To do this effectively, patients need to be diagnosed as early as possible, as only then can optimal preventative measures, both lifestyle and pharmaceutical, be deployed. With the scale and complexity of chronic kidney disease, timely access to specialist care is increasingly required. Referral criteria have changed, with more focus on the 5-year risk of developing end-stage renal disease by using the four variable kidney failure risk equation. One of the major limitations to the effective treatment of people living with chronic kidney disease is hyperkalaemia. The appropriate frequency of testing, assessment and management of hyperkalaemia helps not only reduce the risk of dying from the condition, but also from chronic kidney disease and heart failure, as too often sub-optimal treatment with renin-angiotensin-aldosterone system inhibitors impairs optimal care. Chronic kidney disease is commonly seen in primary care. Patrick Holmes looks at identification and optimal management of the condition