title: Role of the primary care physician in diagnosis and treatment of early renal damage.
abstract: In spite of all the technical advances and resources dedicated to the treatment of endstage renal disease (ESRD), it is still a growing problem all over the world. To address this issue adequately, it is crucial to detect chronic kidney disease patients early and optimize their care. However, a lack of awareness and appropriate management of potential underlying kidney disease, even in high-risk patients, seems to be common in many parts of the world, even though many of the measures recognized to decrease the risk and slow the progression of kidney disease are most effective when initiated early. Type 2 diabetes mellitus patients (a high-risk population) with early nephropathy treated by nephrologists have better preservation of their renal function than do patients treated only by family physicians. However, referral of patients to the nephrologist at earlier stages of disease than is recommended is not always feasible. A more plausible alternative may be that general practitioners learn to diagnose and treat these patients. We have demonstrated that an educational intervention increased family practitioners' clinical competence, which resulted in preserved renal function in diabetic patients with early renal disease. Variables not well controlled either by the nephrologist or the primary care physicians are those related to lifestyle and diet. These unhealthy habits are common in Westernized societies, and primary care physicians may be the most suitably positioned to promote health. Even so, counseling by physicians is not always effective in reducing risky habits, particularly when the health team is overworked; strategies such as community resources (including support groups) may also play a role. Preliminary results of an ongoing study based on a self-help and support group strategy that is coordinated by a multidisciplinary team (family practitioner, social worker, dietician, and physical trainer) show improvements in the lifestyle and dietary habits of patients with overweight or obesity, diabetes, or hypertension. All these findings support the need to implement health promotion programs with the participation of multidisciplinary teams.
authors.affiliation: Unidad de Investigación Medica en Enfermedades Renales, UMAE Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico. a_cueto_manzano@hotmail.com
authors.forename: Alfonso M
authors.initials: AM
authors.lastname: Cueto-Manzano
authors.forename: Laura
authors.initials: L
authors.lastname: Cortés-Sanabria
authors.forename: Héctor R
authors.initials: HR
authors.lastname: Martínez-Ramírez
mesh_terms: D001521:Behavior Therapy; D015984:Causality; D002983:Clinical Competence; D015897:Comorbidity; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D008800:Mexico / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D010346:Patient Care Management / Q000379:methods / Q000592:standards; D010821:Physicians, Family; D011320:Primary Health Care / Q000379:methods*; D012017:Referral and Consultation; D012657:Self-Help Groups