Definition

CKD is a state of irreversible kidney damage and/or a reduction of kidney function that predisposes the patient to further deterioration in renal function. The Kidney Disease Outcome Initiative of the National Kidney Foundation (2002) has established a conceptual framework for the identification, management, and care of all patients with or at risk for kidney disease. CKD is defined as kidney damage irrespective of the level of kidney function for 3 months and/or a glomerular filtration rate (GFR) <60 mL/min per 1.73m2 for at least 3 months, regardless of the underlying etiology (National Kidney Foundation 2002). CKD replaces the terms chronic renal failure (CRF) and chronic renal insufficiency (CRI), which describe renal dysfunction of varying degrees from mild to severe in nature.

CKD is classified in stages based on the severity of illness (Coresh et al. 2005; see Figure 23-1). Higher stages of CKD are associated with poorer kidney function and increasing likelihood of associated complications. CKD stage 5, or end-stage renal disease (ESRD), is defined as a severe, irreversible reduction in function that usually requires renal replacement therapy in the form of dialysis or kidney transplantation to sustain life. The medical management of CKD aims to treat the primary cause of kidney impairment, eliminate or minimize co-occurring physical conditions, prevent or abate the loss of kidney function, treat the metabolic disturbances associated with CKD, prevent and treat cardiovascular disease, and ultimately optimize normal growth and development. The complexity of care, financial costs, and emotional burdens for patients and their families increase as CKD advances.

Stage

Stage

Figure 23-1. Staging and prevalence of chronic kidney disease.

GFR= glomerular filtration rate.

Figure 23-1. Staging and prevalence of chronic kidney disease.

GFR= glomerular filtration rate.

Source. Data from Coresh et al. 2005.

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