VA/DoD CLINICAL PRACTICE GUIDELINE FOR 

THE MANAGEMENT OF CHRONIC KIDNEY 

DISEASE IN PRIMARY CARE

Department of Veterans Affairs

Department of Defense

Patient Guide

QUALIFYING STATEMENTS

The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best 

information available at the time of publication. They are designed to provide information and assist 

decision making. They are not intended to define a standard of care and should not be construed as one. 

Neither should they be interpreted as prescribing an exclusive course of management.

The Clinical Practice Guideline is based on a systematic review of both clinical and epidemiological 

evidence. Developed by a panel of multidisciplinary experts, it provides a clear explanation of the logical 

relationships between various care options and health outcomes while rating both the quality of the 

evidence and the strength of the recommendations.

Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of 

individual patients, available resources, and limitations unique to an institution or type of practice. Every 

healthcare professional making use of these guidelines is responsible for evaluating the appropriateness of 

applying them in the setting of any particular clinical situation. 

The guidelines are not intended to represent TRICARE policy. Further, inclusion of recommendations for 

specific testing and/or therapeutic interventions within these guidelines does not guarantee coverage of 

civilian sector care. Additional information on current TRICARE benefits may be found at www.tricare.mil 

or by contacting your regional TRICARE Managed Care Support Contractor. 

Version 3.0 – 2014

December 2014 Page 1 of 3
Chronic Kidney Disease

Chronic kidney disease (CKD) is a condition in which your kidneys are damaged and cannot filter blood 

as well as healthy kidneys. Because of this, wastes from the blood remain in the body and may cause 

other health problems. [1] CKD is one of the most common serious medical conditions affecting adults in 

the United States. Your illness may be mild without symptoms or can range to a severe illness associated 

with progression to end-stage renal disease (ESRD) which may require dialysis or kidney transplantation. 

Did You Know?

• The CDC estimates that more than 10% of adults in the United States—more than 20 million

people—may have CKD. [1]

• The prevalence of CKD in the Veteran population is estimated to be a third higher than in the

general population.

• The Veteran's Health Administration (VHA) currently cares for over 200,000 Veterans with

moderate to severe kidney disease.

What Causes Chronic Kidney Disease? 

In many patients, CKD is caused by (or linked with) other conditions such as diabetes, high blood 

pressure, heart disease, poor nutrition, and anemia. Figure 1 below shows the percentage of new cases 

of CKD due to some of these conditions. Early treatment is important to stop, or at least slow down, 

kidney damage. The risk of developing CKD increases among people over 50 years of age and peaks after 

70 years of age. [1] Some other risk factors for CKD include:

• A personal or family history of kidney disease

• Diabetes, high blood pressure, or other disease (e.g., chronic heart failure [CHF])

• Systemic illness (e.g., infection with human immunodeficiency virus [HIV])

• Race and ethnicity (e.g., African Americans, Hispanics, Native Americans)

Figure 1. New Cases of Kidney Failure by Primary Diagnosis (2011) 

Source: http://www.cdc.gov/diabetes/pubs/factsheets/kidney.htm

December 2014 Page 2 of 3
How is Chronic Kidney Disease Diagnosed? 

CKD is diagnosed based on your estimated glomerular 

filtration rate (eGFR), or the presence of another 

abnormal kidney condition. 

Although ultrasound and other technologies are not 

required, your health care provider may use them to 

confirm the diagnosis, rule out other conditions, or 

guide your overall treatment plan. 

How is Chronic Kidney Disease Treated?

While there is no cure, CKD can be managed through a combination of provider-recommended treatments 

and self-management strategies. 

Talk to your doctor, nurse practitioner, pharmacist or other health care provider about appropriate 

medications and other approaches to preventing progression of CKD. Also, self-management strategies 

such as diet modifications and other lifestyle changes such as weight loss, exercise, health education and 

smoking cessation should be discussed with your health care provider. 

CKD is a chronic condition, but effective treatments and support are available from the Veterans Health 

Administration and Department of Defense. A comprehensive care and management plan can help you

improve your quality of life. 

References:

1. U.S. Department of Health and Human Services Centers for Disease Control and Prevention.

National chronic kidney disease fact sheet. Atlanta,GA: 2014. 

http://www.cdc.gov/diabetes/pubs/pdf/kidney_factsheet.pdf. Accessed February 24, 2014.

2. Glomerular filtration rate. New York, NY: National Kidney Foundation, Inc.; 2013.

http://www.kidney.org/atoz/content/gfr.

What is an estimated glomerular filtration 

rate (eGFR)? 

This value estimates your level of kidney 

function and determines your stage of 

kidney disease. Your health care provider

can calculate it from the results of your 

blood creatinine test, your age, body size 

and gender. [2]

Where can I find more information? 

The National Kidney Program: http://www.va.gov/health/services/renal

VA e-Kidney Clinic: http://ckd.vacloud.us

The National Kidney Foundation (NKF): http://www.kidney.org/patients

The Centers for Disease Control and Prevention (CDC): https://nccd.cdc.gov/ckd

The National Kidney Disease Education Program (NKDDEP): http://nkdep.nih.gov/

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