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Doctors should optimise the care of patients with chronic kidney
disease before the onset of end stage renal disease, says Malvinder
Parmar (p 85). He warns that appreciable renal dysfunction may be
present even when serum creatinine is normal and reports that the
prevalence of common cardiovascular risk factors is high in chronic
renal disease; early identification and effective control of these risk
factors have been shown to improve patient outcomes.