10 Things a Primary Care Doctor Should Know About Chronic Kidney Disease Patients

If you have kidney disease, chances are you find yourself going on a lot of regularly scheduled doctor’s appointments, even aside from your Nephrologist. During these appointments, you’ll want to look out for a few of these things, and make sure that they do too!

  1. What one doctor considers a normal Serum Creatinine level may not be normal for that patient.

    • Serum Creatinine is creatinine found within the blood

    • It is a normal waste product produced by the muscles due to use

    • Acceptable levels in a patient depend on age, gender, race and body size

    • A doctor cannot tell a patient if their kidneys are functioning normally based on the amount of creatinine in them

  2. Know the medications which can increase Serum Creatinine levels

    • A common antibiotic, trimethoprim-sulfamethoxazole can decrease the amount of creatinine secreted into the body

    • Cimetidione H2, a blocker can also decrease the amount of creatinine secreted 
  3. Patients with decreased GFR or Proteinuria should be screened for the cause

    • A urine dipstick test is normally used

    • Chronic kidney disease (CKD) is defined by kidney abnormality lasting longer than three months

    • But even those with normal GFR may have CKD if they have persistent proteinuria or hematuria of renal origin 
  4. Regular evaluation and intervention is needed for patients with early stage CKD to slow the progression and prevent damage

    • Nephrotoxic drugs should be used with caution or avoided completely

    • Blood pressure should be monitored and controlled

    • Urine protein to creatinine ratio should be obtained periodically

    • CKD patients are at risk for cardiovascular disease. Here, aspirin may be able to help 
  5. Do not automatically discontinue an ACEI or ARB solely because of a small increase of serum creatinine or potassium level

    • ACEI and ARB’s are used to treat CKD and are used to optimize blood pressure control

    • They can prevent the progression of proteinuric CKD

    • Patients taking these drugs will cause an increase of Serum Creatinine 
  6. Anemia patients with CKD need special medications, but do not over-treat them

    • Anemia is associated with fatigue, reduced exercise tolerance, and various heart issues

    • It should be treated with erythrocyte-stimulating agents

    • Doctors must monitor treatment closely 
  7. Phosphate containing bowel preparation should be used with caution

    • It is effective, but in some cases it causes acute phosphate
      nephropathy which will lead to acute renal failure or worsening CKD

    • Doctors should weigh the benefits and risks of alternatives with patients 
  8. Patients with severe CKD should avoid magnesium or aluminum containing oral preparation

    • These are potentially hazardous as they can lead to acute aluminum toxicity

    • Decreased renal functions can cause a build up of these toxins in the body

    • Patients should seek doctor’s advice 
  9. Some patients screened for hypertension should be screened for secondary hypertension, but not everyone

    • Secondary hypertension is relatively uncommon

    • Doctors should know the symptoms; they include hypertension which suddenly gets worse, severe or difficult to control hypertension, or hypertension associated with other clinical findings

    • Other symptoms include headaches, palpitations and sweating 
  10. Patients with reoccurring kidney stone disease need examination to find the right treatment

    • Nephrolithiasis is a common problem treated by primary care physicians

    • Patients with a history of stones or other bowel and urinary issues should be sent to a nephrologist

    • Analyzing the stones is also an important way of gaining information for the patient’s therapy 

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