Chronic Kidney Disease Chronic Renal Failure

CKD is defined as a gradual decrease in renal function over a period of several months to years. Diabetes, hypertension, glomerulonephritis, cystic kidney diseases, and tubulointerstitial diseases (TIDs) are the major causes of CKD. Approximately 6.2 million people are estimated to have a serum creatinine level of >1.5 mg/dl. Unlike in AKI, serum creatinine level does not represent the extent of renal disease in subjects with CKD. Therefore, either actual determination of GFR by radioisotope methods or eGFR is used to assess the severity of kidney disease in a CKD patient. Based on these methods of GFR, a staging system and action plan for CKD was developed (Table 1).

There are several risk factors for the progression of CKD, including hypertension, diabetes, hyperlipidemia, excessive protein intake, smoking, anemia, and genetic predisposition to kidney disease. CKD is one of the major risk factors for cardiovascular disease. Conservative management of CKD includes (i) control of blood pressure (<130/80 for patients with no proteinuria and <120/80 for those with proteinuria > 1 g/day), using dietary sodium restriction < 100 mEq/l, and antihypertensive agents such as angiotensin converting enzymeinhibitors (ACE-Is), or angiotensin receptor-blockers (ARBs) as well as a low dose diuretic; (ii) maintenance of HbA1c < 7% in diabetic patients; (iii) restriction of protein intake <0.8g/kg/day; (iv) maintenance of LDL <100 mg/dl; (v) maintenance of hemoglobin approximately 11-12 g/dl and control of bone disease; and (vi) smoking cessation. Dialysis or kidney transplantation is required if the patient progresses to ESRD.

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