Guest editorial--Chronic kidney disease

Chronic kidney disease is becoming more common in Canada and worldwide, along with cardiovascular disease and diabetes.

Currently, it is estimated that 145 000 people in British Columbia have some kidney impairment (defined as less than 60% of normal function), that 2000 of these are on dialysis, and that the number of dialysis patients is increasing at between 8% and 10% a year nationwide. While not all of the identified 145 000 people will necessarily require dialysis, reduced kidney function can lead to poorer outcomes and adverse reactions to medications and procedures, and can make the management of this patient group difficult. Patients with reduced kidney function are at risk for cardiovascular disease and consume more hospital and health care resources than those with normal kidney function.

This issue focuses on key initiatives in British Columbia regarding chronic kidney disease, including the development of consensus guidelines that help primary care physicians to both screen and care for patients with reduced kidney function. BC lab physicians, nephrologists, general practitioners, cardiologists, internists, endocrinologists, and the Ministry of Health chronic disease management group have collaborated to develop a set of guidelines focused on the screening of high-risk groups, diagnostic and treatment algorithms, and the importance of self-management.

Another important initiative described in this issue involves the efforts of BC labs to ensure that creatinine measurements are consistent and that estimated kidney function reporting is helpful to clinicians. For many years, the diagnosis of kidney disease has been hindered by our reliance on serum creatinine testing, an imprecise measure of kidney function. Recent guidelines published by the National Kidney Foundation have encouraged the use of the estimating equations that more appropriately interpret the serum creatinine values and thereby diagnose impaired kidney function more accurately. British Columbia has recently adopted this practice so that the interpretability of serum creatinine is improved. This initiative is the first of its kind involving multiple laboratory sites, both privately and publicly funded, and is proving highly instructive to others in Canada and internationally.

Other initiatives described in this issue involve identifying and screening populations at risk, and improving shared care—how the various specialties can work together to ensure the best patient outcomes.

Few other health care systems have embarked on such a comprehensive series of initiatives to address chronic kidney disease. We look forward to evaluating the outcomes of these initiatives in the near future.

—Adeera Levin, MD, FRCPC
Professor of Medicine,
Division of Nephrology,
University of British Columbia,
Staff Nephrologist,
St. Paul’s Hospital

Suggested reading

McCullough PA, Sandberg KR, Borzak S. Cardiovascular outcomes and renal disease. Ann Intern Med 2002;136:633-634. PubMed Citation Full Text

Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296-1305. PubMed Abstract Full Text

Anavekar NS, McMurray JJ, Velazquez EJ, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 2004;351:1285-1295. PubMed Abstract Full Text

Duncan L, Heathcote J, Djurdjev O, et al. Screening for renal disease using serum creatinine: Whom are we missing? Nephrol Dial Transplant 2001;16:1042-1046. PubMed Abstract Full Text

Stigant C, Stevens L, Levin A. Nephrology: 4. Strategies for the care of adults with chronic kidney disease. CMAJ 2003;168:1553-1560. PubMed Citation Full Text

Adeera Levin, MD, FRCPC. Guest editorial--Chronic kidney disease. BCMJ, Vol. 47, No. 6, July, August, 2005, Page(s) 286 - Editorials.

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