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Kidney diseases Patient Monitoring

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Patient Monitoring

Adverse outcomes of chronic kidney disease can often be prevented or delayed through early detection and treatment. Earlier stages of chronic kidney disease can be detected through routine laboratory measurements.
Among patients with chronic kidney disease, the stage of disease should be assigned based on the level of kidney function, irrespective of diagnosis.

Management of chronic kidney disease

The primary care physician should provide day-to-day management of patients, and patient education. Patients need to know prognosis and treatment options to make informed decisions.

Stage	Description	GFR (ml/min)	Action Recommendation
0	With risk factors	> 90	Screening, risk reduction
I	Kidney damage with normal or decreased GFR	> 90	Diagnosis and treatment to slow progression, cardiac risk reduction
II	Mild	60 - 89	Monitor to estimate progression
III	Moderate	30 - 59	Evaluate and treat complications
IV	Severe	15 - 29	Prepare for renal replacement therapy
V	Kidney failure	< 15	Renal replacement therapy

Refer the patient to a nephrologist when the serum creatinine is > 1.5 mg/d (> 132.6 µmol/l) for women or > 2.0 mg/dl (176.8 µmol/l) for men, or if creatinine clerance is < 70 ml/min.

Control blood pressure

• Controlled blood pressure can delay the progression to end-stage renal disease
• Target blood pressure: < 130/85 mmHg, the goal should be 125/75 mmHg

Control hyperglycemia

• Tight glucose control (Hemoglobin A1c < 7.0 percent) will delay development of microalbuminuria

Use ACE inhibitor or angiotensin-II-receptor blockers

• They slow progression of chronic kidney disease independently of their other effects
• First-line treatment for patients with diabetes, heart failure, hyperlipidemia, or proteinuria
• Monitor potassium and creatinine levels

Protect remaining renal function

• Avoid pre-renal azotemia by preventing dehydration
• Treat urinary tract infections promptly
• Relieve urinary obstruction
• Review medications

Monitor diet and nutrient therapy

• Adjust diet according to laboratory findings and maintain adequate fluid intake
• Avoid mineral supplements (magnesium) and herbal products (may be nephrotoxic)
• Protein: A low-protein diet is controversial, since many patients with chronic renal disease already have protein malnutrition. Avoid a high-protein diet.
• Phosphorus restriction to 0.8 - 1.3 g/day may become necessary as the disease progresses to prevent renal osteodystrophy

Manage cardiac risk factors

Standard cardiac risk factor management includes stopping smoking, reducing alcohol intake, and initiating an exercise program. Reduce lipids and treat hypertension.

Manage anemia

• Patients with GFR < 60 ml/min/1.73 m2 should be evaluated for anemia

Manage renal osteodystrophy

• Renal osteodystrophy usually starts when the creatinine clearance is 50 - 70 ml/min/1.73 m2 or less
• Monitor calcium and phosphorus levels. Calcium levels should be maintained within the normal level of 9 - 11 mg/dl (2.25 - 1.75 mmol/l).

Roche Diagnostics' Near Patient Testing products support you in monitoring and managing your patients with kidney diseases. Combur-Test® urine test strips are most suitable for rapid screening for urinary tract infections, proteinuria, and hematuria. For early detection of microalbuminuria, particularly if diabetic or hypertensive nephropathy is suspected, use Micral-Test®, an immunological test which allows the specific detection of human albumin in urine. With a cut-off at 20 mg/l the sensitivity is 97 percent and the specificity is 71 percent.

The Accutrend® meters are ideal to assess the lead parameters of metabolic disorders from capillary blood and hence to evaluate key cardiovascular risk factors.

Using Reflotron® Tests with Reflotron® Plus or Reflotron® sprint you can easily monitor the kidney function of your patients in the primary care environment within minutes by measuring creatinine, urea and uric acid. These instruments provide reliable values by using whole capillary or venous blood, serum or plasma.

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