Rising creatinine: Pharmacological management of CKD

Fluent management of CKD - in preventing or delaying the commencement of dialysis - improves the quality of life and mortality.

With an ageing and increasingly comorbid population, confidently managing patients with kidney impairment will be essential for clinicians in all areas of medicine. Given its inextricable relationship to hypertension and diabetes, no more so than in general practice.

Medication and kidney function is also a considerable cause of angst amongst clinicians, and for good reason - but it's often the very agents that provide the most benefit (including delaying dialysis by years) that cause the most confusion or are incorrectly stopped or withheld.

Learning outcomes:

• When to use different measures of kidney function (serum creatinine, eGFR, creatinine clearance calculations).
• When is a rise in serum creatinine not evidence of an acute kidney injury?
• Rises in serum creatinine when starting an ACE inhibitor, ARB, or SGLT2 inhibitor.
• Important pillars of management in diabetic and non-diabetic CKD.
• The significance of proteinuria - both prognostically and in goals of treatment.
• When to call for help - requesting specialist renal input for a patient with pre-dialysis CKD.

Acknowledgements

Content created by Dr Sylvia Giles with expert review by Rob Walker, Professor in the Department of Medicine, University of Otago, Dunedin, and consultant Nephrologist for Te Whatu Ora.

This eLearning is supported through an unrestricted educational grant from: