Chronic kidney disease: a practical guide (ACT-NAU)

Chronic kidney disease (CKD) is a major public health problem that is associated with increased global morbidity and mortality and is a major risk factor for cardiovascular disease. The prevalence of CKD is increasing exponentially worldwide. Its prevalence in Portugal is 20.9% in CKD stages 1 to 5, and 9.8% for CKD stage ≥G3a/A1, so it is of utmost importance that this health problem be properly addressed in primary health care. The most common causes of CKD are hypertension and diabetes, and regular screening for CKD in these patients is recommended. Other contributing factors to CKD include acute kidney injury, obesity, smoking, infectious diseases, nephrotoxic drugs and, less frequently, contaminants in food or drinking water, heavy metals, industrial and agricultural chemicals, and high ambient temperatures. CKD is a major burden on health care systems with a propensity to increase due not only to the increasing prevalence of hypertension and diabetes but also to the aging population. This will result in greater demand on the healthcare system, greater consumption of resources, and greater economic expenditures on healthcare. Thus, it is of uttermost importance to develop awareness among physicians to prevent CKD and its risk factors, to properly screen for early diagnosis, and to correctly treat and refer to secondary health care facilities. To improve the care of patients with CKD and strengthen communication between healthcare providers, we present a document with the backbone guidelines for diagnosing CKD, its management according to its various etiologies, and referral criteria to hospital care.