Role of the family physician in controlling the epidemic of chronic kidney disease.

: The term chronic kidney disease (CKD) signifies permanent reduction in renal function. It consists of 5 stages of increasing severity. CKD replaces the multiple terms like chronic renal failure in vogue earlier. The prevalence of CKD is rapidly increasing in the community and causing a huge burden on the community. Since the current marker of renal function-serum creatinine is not sensitive enough, measurement of estimated glomerular filtration rate (eGFR) has been proposed to quantify the renal function better. The family physician has a vital role to play in preventing the onset and progression of CKD. Prevention starts with maintaining a healthy lifestyle. The groups at risk for developing CKD like diabetics and hypertensives should be effectively treated. Yearly estimation of albuminuria (or microalbuminuria) and estimated GFR should be done. Optimal use of renoprotective drugs can delay the inevitable progression of CKD to end-stage renal disease (ESRD). The family physician is the key person, who can implement these measures at the primary care level. Referral to a nephrologist can be made once initially when the serum creatinine >2 mg% to establish the primary diagnosis; and subsequently the patient can be managed in consultation with the nephrologist. Only such an Integrated approach with the active participation of the family physician can successfully stem the upsurge in the tide of CKD.