According to current guidelines, the presence of chronic kidney disease (CKD) should be established, based on presence of kidney damage and level of kidney function (glomerular filtration rate [GFR]), regardless of diagnosis.1 In general, patients with a GFR lower than 30 mL/min/1.73 m2 (stage 4 CKD) should be referred to nephrologists.1 Ideal management of patients with CKD should include treatment to slow progression of kidney disease; prevent cardiovascular events; address the complications of CKD, such as anemia, disordered mineral and bone metabolism (CKD-MBD), and protein-energy wasting; and prepare for end-stage renal disease (ESRD). Internists are well versed in the management of hypertension and hyperlipidemia in patients with CKD, targeting a blood pressure lower than 130/80 mm Hg, preferentially using angiotensin converting–enzyme (ACE) inhibitors or angiotensin receptor antagonists (ARBs) among patients with diabetes or other kidney diseases associated with heavy proteinuria, and considering patients with CKD to be in the highest risk category for cardiovascular disease.1
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 2
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.