[Proactive approach to patients with chronic kidney disease--the role of general practitioner]. / Proaktivni pristup zbrinjavanju bolesnika s kronicnim bolestima bubregauloga lijecnika obiteljske medicine.

Chronic kidney disease (CCD) is both public health and economic problem worldwide. Every 10th person in the world suffers from CCD. Its major outcomes include progression to chronic kidney failure and cardiovascular morbidity and mortality. Routine use of diagnostic tests [creatinine level, microalbuminuria test-strips and MDRD formula to estimate glomerular filtration (eGF)] could improve early detection of kidney damage. However, those methods are rarely used in Croatia. Both international and national professional societies guidelines clearly recommend use of erythropoesis stimulating agents (ESA) in predialysis, dialysis and patients with kidney transplant, but mechanisms of guidelines implementation are not properly developed. In patients with CCD with Hb level constantly (2 lab tests within 2 weeks) below 110 g/l, and other causes of anemia excluded, ESAs should be prescribed. Before beggining of ESAtherapy, iron supplementation should be performed when required. By using systematic approach to population in care, GP could identify asymptomatic patients with CCD. Early intervention and treatment could prevent or delay its progression to kidney failure.