Role of health networks in the screening and management of chronic kidney disease

Chronic kidney disease is a public health problem in terms of both the number of patients treated with dialysis or transplantation and the cost of renal replacement therapies, and the excess cardiovascular risk associated with it even at earliest stages. The population of people with chronic renal insufficiency (defined by a glomerular filtration rate < 60 mL/min) and therefore exposed to the risk of progression towards end-stage renal failure and excess cardiovascular risk includes roughly 5% of the general population. There are currently effective treatments to slow the progression of chronic kidney disease, delay or ovoid dialysis, and prevent cardiovascular events. These treatments are most effective when begun earliest and when followed by professionals aware of the risk factors and the intermediate efficacy criteria: blood pressure, proteinuria, diet, anemia, etc. (Anaes, 2004). Screening for chronic kidney disease is currently facilitated by the routine estimate of creatinine clearance with Cockcroft's formula at every serum creatinine assay (Anaes, 2002). Nephrologists play an essential role when kidney disease is discovered, for it is they who must recognize diseases related to specific treatments and thus to define the long-term risk prevention strategy. Chronic kidney disease develops over years, dung which time the patient will see a variety of different healthcare professionals. The transmission of medical information between them is a prerequisite for the continuity of nephroprotective treatment, the prevention of avoidable causes of aggravation (drugs, contrast products, etc.), and the quality of preparation for substitution treatment and transplantation. Because of late referral to nephrologists and insufficient information, an elevated proportion (about 40%) of patients start dialysis in emergency conditions, which reduces their chance of maintaining their independence and using a home-based dialysis method. The system of health networks should provide responses particularly appropriate to the needs of patients with chronic kidney disease. In particular, these networks promote continued medical education, consistent and thorough patient information, and evaluation of practices (HAS, 2006).