Introduction: chronic kidney disease: a burgeoning health epidemic.

BACKGROUND

The kidneys function as excretory, biosynthetic, and metabolic organs, vital for maintaining normal physiology. Although dialysis can replace some kidney functions, it cannot replicate the biosynthetic and metabolic activities of the normal kidney. Chronic kidney disease (CKD) and its terminal complication, end-stage renal disease (ESRD), may progress undetected until immediately before symptomatic kidney failure develops. At this point in the disease process, few opportunities exist to prevent adverse outcomes.

OBJECTIVES

To (1) review the incidence, prevalence, and staging of CKD and ESRD and (2) elucidate that the management of CKD is suboptimal and costly.

SUMMARY

CKD is defined according to the presence or absence of kidney damage and level of kidney function. The Kidney Disease Outcomes Quality Initiative designates 5 stages of CKD, with stage 5 being ESRD -- the point at which patients' loss of kidney function precipitates a need for dialysis or kidney transplant. The United States Renal Data System has documented monumental growth of the ESRD population and its significant impact on Medicare and its budget. In 2005, approximately 1.2% of Medicare's 31 million beneficiaries who had ESRD generated 6.4% of Medicare's total costs. One of the most important aspects of CKD diagnosis and treatment is early detection and aggressive management of underlying causes. However, care for CKD patients is fragmented. Primary care physicians, cardiovascular specialists, endocrinologists, dietitians, and pharmacists may be engaged in the patient's care early but the nephrologist may not be approached until late, if at all.

CONCLUSION

CKD is costly. Preventing progression to ESRD may improve quality of life and help save health care dollars. A concerted approach to manage CKD patients effectively starts with early detection and integrated management by multiple specialties. Delaying disease progression is crucial and must include patient education and aggressive treatment and management of CKD and its comorbidities. Interdisciplinary care models in which pharmacists are integrally involved should be replicated.