Pathways and Stages Kidney disease pathway hematuria pathway diabetes pathway non-diabetic MRP CKD stages referral sheet
    Disclaimer: The information and data in this document ("Information") is based on scientific evidence current as of the date issued and is subject to change without notice. The Information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Any person consulting or applying the Information is expected to use independent medical judgment and expertise in the context of individual clinical circumstances. Winnipeg Regional Health Authority and the Manitoba Renal Program make no representation or guarantees of any kind whatsoever regarding the content or use or application of the Information and specifically disclaim any responsibility for its application or use in any way.

Information About CKD

  • Chronic kidney disease (CKD) is a major health concern in Canada, believed to affect more than 2 million Canadians. There are almost 22,000 Canadians on dialysis and ~15,000 living with a functioning renal transplant.
  • Manitoba has the second highest incidence and prevalence of end-stage renal disease (ESRD) in Canada
  • CKD is defined as kidney damage for ≥ 3 months, defined by structural or functional abnormalities, with or without a reduction in glomerular filtration rate (GFR). The National Kidney Foundation has classified CKD into 5 stages for better detection and management of CKD.
  • CKD commonly coexists with other diseases such as hypertension, diabetes, and cardiovascular disease (CVD). Early detection of CKD and subsequent management of risk factors for disease progression is paramount.
  • Patients with CKD are at increased risk for CVD, thus CVD risk factors should be aggressively managed.
  • Diabetes is the leading cause of ESRD, accounting for ~ 30-40% patients on dialysis or living with a renal transplant. Treatment strategies in these patients are directed at glycemic control, hypertension management, lipid-lowering therapy, and cardiovascular risk factor reduction (see “Diabetic Nephropathy Management” guidelines pathway)
  • For non-diabetic patients with CKD, it is important to distinguish between proteinuric and non-proteinuric disease, as treatment strategies may differ (see “Non-diabetic Kidney Disease” guidelines pathway)
  • In later stages of CKD, patients may develop complications of renal disease. These include anemia, mineral metabolism disorders, malnutrition, cardiomyopathy and chronic fluid overload. These patients should be followed by a nephrologist to assist the primary care physician in the patient’s care.
  • It is estimated that approximately 10% of the adult population may have CKD predominantly stages 1 through 3. However most of those, in the absence of albuminuria, will not have progressive CKD. To avoid the potential psychosocial implications of falsely classifying those at low risk of progression, and to avoid the potential economic costs of increased interventions, it is imperative to appropriately classify and assess only those at risk of CKD progression and/or CVD.