Chronic Kidney Disease Stages 3 - 4
Chronic kidney disease is the ninth leading cause of death in the U.S. The two main causes of chronic kidney disease are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases. It affects 11% of the U.S. population over the age of 65, and those affected are at increased risk of cardiovascular disease and kidney failure. Ethnic minority populations are more likely to develop kidney failure, particularly African-Americans (four times more likely than Whites), Hispanics (two times more likely than Whites), and American Indians (three times more likely than Whites).
Early manifestation of CKD in individuals with diabetes is often underdiagnosed due to the absence of an annual urinary microalbumin test to identify kidney damage. While early kidney disease has no symptoms, if left undetected, it can progress to kidney failure, which requires dialysis or transplant.
Primary Care Providers & Hospitals
Consider getting started with the following changes:
Change Concept 2 - Timely referral to nephrologist
Change Concept 12 - Modify hospital systems to detect CKD and promote AV fistula planning and placement
Educational Materials
The following tools are designed for primary care providers to enhance their understanding of CKD.
Help, I Need Dialysis! How to have a good future with kidney disease
This new publication by Dori Schatell, MS and Dr. John Agar will help CKD patients learn how they can have the best possible life with dialysis. This publication can be ordered from Life Options ($14.99, plus shipping and handling).
CKD Wallet Card
CKD Quick Reference Guide for the Primary Care Provider -
Developed by the Upstate New York Practice Board Research Network and Revised by the FFBI Community Education and Clinical Practice Workgroups
CKD Assessment Algorithm, Emergency Room Visit
Developed by The Renal Network of the Upper Midwest, Inc.
CKD Assessment Algorithm, Patient Office Visit
Developed by The Renal Network of the Upper Midwest, Inc.
CKD Treatment Algorithm
Developed by The Renal Network of the Upper Midwest, Inc.
Fistula Preservation, Development, and Maintenance Policy and Procedure
CKD Stage 4 AV Fistula Planning Algorithm
PICC Line Recommendations
FFBI white paper recommending that PICC lines not be placed in anyone identified as having mid-Stage 3 chronic kidney disease (CKD), Stage 4 and 5 CKD or ESRD with instructions to obtain GFR estimates for all patients with high serum creatinine levels, and to defer a PICC line decision until it is clear that the patient does not have CKD.
Recommendation for the Avoidance of Radial Artery Access for Procedures
This document discusses avoidance of the radial artery as an acess vessel for cannulation in patients with CKD stage 4, 5 or ESRD due to possible loss of upper extremity vasculature.
American Nephrology Nurses Association (ANNA) "Save the Vein" Project
This program focuses on the importance of vein preservation in chronic kidney disease (CKD) patients. At the heart of the project is a silicone wristband that reads “SAVE VEINS – NO IV/LAB DRAWS” for patients to wear to minimize the vascular trauma prior to placement of a fistula. A patient education brochure helps educate the patient about the importance of vein preservation. Information about ordering STV wristbands and brochures is available from the ANNA Save the Vein website.
Vein Preservation Tools
Laboratory Testing
FFBI Coalition member, National Kidney Disease Education Program (NKDEP), has organized a Laboratory Working Group (LWG) that promotes early detection and management of CKD through laboratory measurement and reporting. Visit the NKDEP website to learn more.