Patients with CKD need to take an active role in managing their disease and monitoring their progression to more advanced stages such as glomerular filtration rate (GFR) category G4 to G5. Dietary therapy such as restriction of potassium, phosphorus and salt, protein, and fluids is typically advocated for GFR category G3 to G5. [ ] [ ] Lifestyle changes that would include medical compliance, optimization of glycemic control, and blood pressure control are the leading factors that delay progression of CKD and the need for renal replacement therapy. As patients enter GFR category G4 CKD, it is recommended that they attend educational classes at a CKD clinic where different dialysis modalities such as hemodialysis and peritoneal dialysis are discussed, to determine their option of choice. Also, patients may be evaluated for kidney transplantation and referred to a transplant center at this time. Once a patient has been educated and the dialysis modality has been chosen, referral for surgery may be done for dialysis access placement.
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