Chronic kidney disease: Issues and establishing programs and clinics for improved patient outcomes

Wendy L. St. Peter, Anton C. Schoolwerth, Tracy McGowan, William M. McClellan

Research output: Contribution to journalReview articlepeer-review

81 Scopus citations


The spectrum of chronic kidney disease (CKD) extends from the point at which there is slight kidney damage, but normal function, to the point at which patients require either a renal transplant or renal replacement therapy to survive. Epidemiological studies suggest there are approximately 20,000,000 patients with various stages of CKD. These patients have many comorbidities, including cardiovascular disease, hypertension, diabetes, anemia, nutritional and metabolic derangements, and fluid overload. Unfortunately, evidence shows that current CKD care in the United States is suboptimal, and late referral to a nephrologist is often the rule and not the exception. Roles of primary care physicians (PCPs) and nephrologists in the care of patients with CKD remain undefined. Several studies have suggested that care provided by multidisciplinary nephrology teams can improve patient outcomes. Currently, there are published evidence-based clinical practice guidelines for anemia management, nutritional therapy, and vascular access placement, with other CKD guidelines under development. The intent of this review includes providing compelling evidence for earlier screening, identification, and management of patients with CKD; showing that current CKD care is suboptimal; encouraging the development of multidisciplinary teams that provide collaborative care to patients with CKD, suggesting roles for PCPs and nephrologists in the care of these patients; describing CKD initiatives from national organizations; and providing a comprehensive checklist that can guide the development of CKD clinics and programs.

Original languageEnglish (US)
Pages (from-to)903-924
Number of pages22
JournalAmerican Journal of Kidney Diseases
Issue number5
StatePublished - May 1 2003

Bibliographical note

Funding Information:
Supported in part by an educational grant from Ortho Biotech Products, LP.

Copyright 2008 Elsevier B.V., All rights reserved.


  • Anemia
  • Chronic kidney disease (CKD)
  • Collaborative management
  • Diabetes
  • Dyslipidemia
  • Early referral
  • Hypertension
  • Late referral
  • Malnutrition
  • Metabolic acidosis
  • Patient outcomes
  • Program development
  • Referral patterns
  • Renal osteodystrophy


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