By: Dr. José Luis Nieves Rivera, Nephrologist
MCS Provider and Collaborator
June 2024

The prevalence of chronic kidney disease is increasing in our population, and people with diabetes and hypertension are the most likely to develop it. Having high blood sugar levels and uncontrolled hypertension for a long period of time can cause significant and irreversible damage, both macro and microvascular, and accelerate the progress of chronic kidney disease.

Therefore, it’s of the upmost importance for nephrology specialists and primary care physicians to work as a team to educate patients on how to take care of their kidneys and identifying cases early for timely interventions, management, treatment and referrals. To achieve this, it’s imperative for primary care physicians to talk to their patients about chronic kidney disease, caring for their kidneys, and the potential complications of this condition. Among the recommendations they should offer patients are:

• Adequate water consumption

• Limiting the use of anti-inflammatory drugs (NSAIDs)

• Not smoking

• Limiting the consumption of alcohol

• Maintaining a balanced diet

• Physical activities (ex. walking, bicycling, elliptical)

When kidney diseases are developing, they usually don’t have any symptoms. These tend to appear during advanced stages higher than 3b. Therefore, it’s essential to identify the risk factors in our population, and thus facilitate early identification of the disease. Some modifiable risk factors include:

• Uncontrolled blood pressure

• Hyperglycemia

• History of acute kidney failure

• The recurring use of anti-inflammatory drugs (NSAIDs)

On the other hand, non-modifiable risk factors include:

• A family history of kidney disease, diabetes and hypertension

• Age

• Race

Given the lack of symptoms, it’s essential for primary physicians to consider the early detection of kidney disease during the intervention and routinely perform the recommended screenings, especially in patients with the risk factors mentioned above. Screenings include:

1. Blood Creatine: Reflects kidney function. Alterations may indicate deterioration or a decrease in kidney function.
2. eGFR: A kidney function calculation, whereby the patient’s age, sex, race and creatine levels are estimated. This is useful for estimating stages
3. Urinalysis: Reflects whether the patient has good blood glucose control.
4. A1C:Reflects whether the patient has good blood glucose control.
5. Lipid Panel: Cardiovascular risk marker. .
6. Spot Urine for Total Protein and Spot Urine for Creatine: The principal markers of kidney damage at the glomerular level.

   Note: Microalbumin can be used to detect proteinuria. However, once detected, it must be followed up with total spot protein/spot creatine, as it provides a better estimate almost comparable to the 24-hour urine collection for total protein.

7. Electrolyte Levels: Monitors electrolyte levels, including potassium, sodium and bicarbonate.
8. Renal Imaging: If necessary, a sonogram may be performed to check for structural or obstructive damage.

A patient presenting risk factors with the condition, along with any screening abnormalities, should be referred to the nephrologist for evaluation. During the consultation with the nephrologist, the patient’s history and vital signs are reviewed and documented, along with any drugs, supplements and tests. The patient is then provided guidance regarding the functioning of his or her kidneys, what stage they are in, and what actions can be taken to prevent deterioration.

Often, patients are afraid to come to the specialist’s office because they’re afraid of the word “dialysis.” However, those who are at the lower stages may only require guidance (an evaluation such as the one described above), and can return to their primary physician with follow-up instructions. Those patients with Stage 3 or higher and proteinuria need a complete treatment plan requiring follow-up visits with their nephrologist every three (3) to six (6) months.

For those patients whose condition progresses over time, a loss of more than 70% in their kidney function may be observed, and dialysis may be required. It’s important to emphasize that in these cases, there’s no reversibility. Patients may present an accumulation of toxins in the body, fatigue, weakness, fluid retention edema (swelling in the legs, ankles or around the eyes), and are usually more prone to cardiovascular diseases, strokes, anemia and disorders in bone mineralization. These complications associated with the patient’s condition impact the person’s quality of life, and affect one’s ability to work, socialize and perform daily activities. In many cases, mental health conditions, such as depression and anxiety, can also be triggered.

By working collaboratively with primary care physicians, nephrologists can help optimize patient care and prevent the progression of kidney disease. This improves the quality of care while promoting the holistic treatment of kidney disease and its associated comorbidities.

MCS has clinical programs to support care plans established by primary physicians and specialists for patients with care conditions. Our goal is to improve the quality of health care for our members while helping them achieve their treatment goals and objectives.