Slowing Chronic Kidney Disease Progression

Most nurses have worked with patients with chronic kidney disease (CKD). Their condition may have been related to diabetes, high blood pressure, an acute infection, or other assaults on the kidney. I’ve tended to see a diagnosis of CKD as the beginning of an inevitable decline. Certainly, “prevention” didn’t seem a relevant concept at this point; my role was to assess and monitor, teach and support, and hope for the best.

Fig. 1. The Nephron. Blood flows into the nephron through the glomerulus. Filtrate from the glomerulus flows into Bowman’s capsule, then through the proximal tubule, the loop of Henle, and the distal tubule, a series of tubules that modifies the filtrate primarily by reabsorbing water and needed electrolytes into the bloodstream. The modified filtrate (urine) then flows into the collecting duct and eventually drains into the renal pelvis. Courtesy of National Kidney Disease Education Program and the NIDDK.

However, the authors of the February CE feature, “Improving Outcomes for Patients with Chronic Kidney Disease,” make it clear that many of us (nurses as well as physicians) aren’t up to date about what we can do to slow the progression of CKD. As authors Norton et al. note:

“The greatest opportunities to reduce the impact of CKD arise early, when most patients are being followed in primary care; yet many clinicians are inadequately educated on this disease.”

The authors note that, despite the availability of evidence-based guidelines for managing CKD, expert recommendations are poorly implemented. This AJN article, part 1 of a two-part series, presents the evidence that when clinicians provide thoughtful care based on what we now know about CKD, patients do better. Disease progression is delayed, hospitalizations are shorter, and the incidence of cardiovascular complications, infections, and unplanned urgent dialysis is reduced.

The Effects of Standardizing CKD Care

The work of two of this article’s authors makes clear that progress is possible when a concerted effort is made to standardize care based on well-established CKD guidelines. Gayle Romancito, is a renal case manager at the Public Health Nursing Department at the Zuni Comprehensive Community Health Center in New Mexico; Andrew Narva is a nephrologist who served that community for nearly 25 years. In the U.S., diabetes accounts for 44% of new cases of end-stage renal disease (ESRD) in the overall population, but for 69% of new ESRD cases in the American Indian/Alaska Native population. As part of the Special Diabetes Program for Indians (SDPI), established by Congress in 1997 to support expert diabetes care at Indian Health Service facilities, Romancito and Narva contributed to a remarkable 54% drop in the incidence of kidney failure from diabetes among Native Americans over a 17-year period.

This month’s article provides an overview of CKD, its diagnosis and etiology, and ways to slow disease progression. Part 2, coming in March, will address complications of CKD and the treatment of kidney failure.