Section 4: Other Complications of CKD: Cardiovascular Disease, Medication Dosage, Patient Safety, Infections, Hospitalizations, and Caveats for Investigating Complications of CKD
This section is included as a reminder that it is important to appreciate the complexity of evaluating and treating patients with CKD and other conditions. We identified issues of patient safety and areas of evaluation of CKD patients for common conditions (heart disease and diabetes), and used this section to remind the practitioner to identify important events like infection, acute kidney injury, and imaging studies as modifiers of risk (of progression and of death), and as related to patient safety. We wanted to provide the reader with comprehensive guidance for common clinical scenarios. Also we highlight potential misunderstandings regarding common tests. For example, prognosis and treatment algorithms for elevations of B-type natriuretic peptide and troponin have not been evaluated and validated in CKD populations. We emphasize that those with CKD and evidence of cardiac disease be treated in accordance with best practices for those without CKD (i.e., appropriate diagnostic studies or/and medications should be offered). The value of hemoglobin A1c in patients with diabetes with more advanced CKD remains problematic, a fact not necessarily appreciated by many. We have listed in a table the commonly used drugs in CKD, and those needing dose reduction or cessation.
We hope that the tables and issues identified in this section will be useful tools for practitioners. This section highlights the complexity of care associated with CKD in terms of diagnosis, monitoring, and treatment options.