Individuals should have regular checkups that include a routine urinalysis and calculation of the estimated GFR
Diabetes or hypertension
People with a history (or a family history) of kidney disease
Repeated urinary tract infections
People with diabetes need to have their urine checked for albuminuria if routine urinalysis is negative for protein.
Report any changes in urine appearance (color, odor), frequency, or volume to HCP
Monitor kidney function with serum creatinine and BUN and GFR if are on potentially nephrotoxic medications
Prevention and detection of chronic kidney disease
Early detection and treatment are the primary methods for reducing chronic kidney disease.
Monitor BP to detect elevations so that treatment can be started early.
Treat hypertension appropriately and aggressively, since it is the second leading cause of chronic kidney disease.
Ensure proper diagnosis and treatment of diabetes mellitus, since it is the leading cause of chronic kidney disease.
Glycemic control for patients with diabetes
Acute care
In-hospital care is required for management of complications and for kidney transplantation (if applicable)
Ambulatory care
Encourage the patients to participate in their care
Include the following information in the teaching plan for the patient and caregiver.
Dietary (protein, sodium, potassium, phosphate) and fluid restrictions.
Difficulties in modifying diet and fluid intake.
Signs and symptoms of electrolyte imbalance, especially high potassium.
Alternative ways of reducing thirst, such as sucking on ice cubes, lemon, or hard candy.
Rationales for prescribed drugs and common side effects.
Examples:
Phosphate binders (including calcium supplements used as phosphate barriers) should be taken with meals.
Calcium supplements prescribed to treat hypocalcemia should be taken on an empty stomach (but not at the same time as iron supplements).
Iron supplements should be taken between meals.
The importance of reporting any of the following:
Weight gain >4 lb (2 kg)
Increasing BP
Shortness of breath
Edema
Increasing fatigue or weakness
Confusion or lethargy
Need for support and encouragement. Share concerns about lifestyle changes, living with a chronic illness, and decisions about type of dialysis or transplantation.
The expected outcomes are that the patient with CKD will maintain
Fluid and electrolyte levels within normal ranges
An acceptable weight with no more than a 10% weight loss
