Rhode Island Kidney Care Connection
Furthering Kidney Health for Patients
With Diabetes
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Slowing the Progression of Chronic Kidney Disease
Even though more than 26 million adult Americans have chronic kidney disease (CKD), very few actually die from kidney failure. Instead, CKD patients commonly develop secondary conditions that complicate their kidney disease and may result in death.
As CKD has no known cure, the medical community and patients need to focus on slowing the progression of the disease through disease management.
This can be done by emphasizing the following 10 steps:
- Treating the Underlying Condition - CKD is commonly caused by high blood pressure or diabetes, but sometimes kidney disease is the result of several factors - a secondary disease, medication usage or physical damage. The best management plan is to perform a comprehensive diagnostic evaluation, determine the cause of the kidney disease and commence with appropriate therapy whenever possible.
- Controlling Blood Pressure - High blood pressure not only causes kidney disease, but can be a secondary condition caused by CKD and attributing factors. Hypertension should be treated aggressively with blood pressure being kept below 130/80.
- Using an ACE Inhibitor or ARB - Studies have shown that using an ACEI or ARB is effective in slowing the progression of CKD. Follow up with patients to assure they are filling prescriptions and taking their medications as prescribed. Ensuring compliance is very important in CKD patients taking an ACEI or ARB.
- Reducing Proteinuria - Proteinuria is the measure of how much protein passes across the membrane of the kidney. It can be monitored using a simple test known as the urine ratio of protein or also known as Albumin and Creatinine. ACEIs and ARBs reduce the amount of proteinuria by slowing the progression of CKD.
- Controlling Diabetes - Maintaining the blood glucose level close to normal can reduce complications associated with diabetes, such as diabetic retinopathy, neuropathy and nephropathy.
- Controlling Excess Body Mass - Obesity is associated with a variety of problems ranging from diabetes and hypertension to increased cardiovascular events and higher cancer rates. Patients (especially those in the predialysis stage) should maintain a healthy weight.
- Exercising - Exercising does the body good! CKD patients should participate in low impact exercise for 20 to 30 minutes a day as the activity improves a person's quality of life and well-being.
- Controlling Lipids - Although dyslipidemias have been associated with kidney disease, it is uncertain whether lipid-lowering therapy will protect the kidney. It may, however, benefit the prevention of secondary cardiovascular diseases.
- Refraining from Cigarette Smoking - Encourage patients to quit smoking, as studies show current and former smokers have a higher risk for proteinuria and damage to the kidneys that is irreversible.
- Avoiding Drugs Known to Damage Kidneys - Several medications (such as NSAIDs) promote/accelerate the progression of CKD. Decreased kidney function leads to accumulation of pharmaceutical metabolic waste that can be toxic to the kidney and other organs. Keep this in mind when prescribing new medications and educate patients about excess use of over-the-counter medications.
Slowing the progression of kidney disease is a joint collaboration between the physician and the patient. The importance of understanding the impact of lifestyle behaviors in slowing the progression and management of CKD is critical.
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November is Diabetes Awareness Month
Diabetes has reached epidemic proportions. Nearly 24 million children and adults in the United States live with diabetes. In 2006, an estimated 63,000 Rhode Island adults aged 18 years or older had diagnosed diabetes.
If current trends continue, one in three children born today will face a future with diabetes.
These statistics, coupled with the personal struggles of people with diabetes and their loved ones, underscore the need for action. So, during American Diabetes Month this November, the American Diabetes Association is launching a bold movement to confront, fight and eventually Stop Diabetes.
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This material was prepared by Quality Partners of Rhode
Island, the Quality Improvement Organization for Rhode Island, under
contract with the Centers for Medicare & Medicaid Services (CMS),
an agency of the U.S. Department of Health and Human Services.
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ACEI/ARB use for CKD
A substantial and growing body of evidence has been published confirming the importance of either an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB) in the treatment or prevention of a number of disease states.
Both classes of drugs have been shown to slow the progression of kidney disease by significantly reducing proteinuria, delaying transition from micro- to macroalbuminuria and slowing the decline in glomerular filtration rate (GFR).
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NKDEP - Videos
To support and encourage conversations between health professionals and patients, the National Kidney Disease Education Program (NKDEP) has developed a series of short videos that show possible approaches health professionals can use to explain different aspects of CKD.
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Contact Us
For information or technical assistance on Quality Partners' Chronic Kidney Disease Project, please contact Lynn Pezzullo.
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