Practical recommendations for treating patients with chronic kidney disease in Australia : a multidisciplinary approach

BACKGROUND: Chronic kidney disease (CKD) is a significant public health challenge in Australia, affecting ~10% of the adult population and contributing to substantial morbidity and mortality. Diabetes, hypertension, cardiovascular disease and CKD frequently co-exist; therefore, a multidisciplinary approach is necessary to manage these conditions. Recent advances in pharmacological therapies, particularly for diabetic kidney disease (DKD), can improve clinical outcomes. Current guidelines may not fully address the complexities of CKD management across all levels of care in the Australian context. OBJECTIVE: To develop simple, practical, evidence-based recommendations to guide healthcare practitioners in improving CKD management across Australia. METHODS: A multidisciplinary panel of eight healthcare practitioners (nephrologists, cardiologists, endocrinologists and general practitioners) employed an adapted virtual nominal group technique to achieve consensus on CKD management recommendations. RESULTS: The panel developed nine unique recommendations; five achieved consensus, and four were in accordance with GRADE guidance: Both urine albumin-to-creatinine ratio (uACR) and estimated glomerular filtration rate (eGFR) should be assessed regularly in patients at increased CKD risk. Most patients with CKD can be managed in primary care, with specialist referral when required. Ensure all cardiometabolic risk factors are assessed and managed proactively. For patients with diabetic kidney disease, consider the four pillars of therapy. CONCLUSION: These multidisciplinary consensus recommendations provide actionable guidance for Australian healthcare practitioners to improve CKD management across all levels of care, addressing the unique needs of the Australian healthcare landscape.