Chronic Kidney Disease and Its Complications

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Chronic kidney disease (CKD) is a complex disease affecting more than 20 million individuals in the United States. Progression of CKD is associated with a number of serious complications, including increased incidence of cardiovascular disease, hyperlipidemia, anemia, and metabolic bone disease. CKD patients should be assessed for the presence of these complications and receive optimal treatment to reduce their morbidity and mortality. A multidisciplinary approach is required to accomplish this goal.

Section snippets

CKD classification/staging

CKD is defined as the presence of kidney damage, manifested by abnormal albumin excretion or decreased kidney function, quantified by measured or estimated glomerular filtration rate (GFR), that persists for more than 3 months [2], [3]. Although creatinine clearances can be calculated from urine creatinine concentration measured in a 24-hour urine collection and a concomitant serum creatinine concentration, a more practical approach in the office is to estimate GFR (estimated GFR or eGFR) from

Chronic kidney disease–associated anemia

Anemia is defined as a reduction in one or more of the major red blood cell measurements: hemoglobin concentration, hematocrit, or red blood cell count. The World Health Organization defines anemia as a hemoglobin level less than 13 g/dL in men and postmenopausal women, and less than 12 g/dL in premenopausal women [6]. The NKF defines anemia as a hemoglobin of less than 13.5 g/dL in men and less than 12.0 g/dL in women [2].

A normochromic, normocytic anemia usually accompanies progressive CKD [7]

CKD-associated mineral and bone disorders

The term “CKD-associated mineral and bone disorders” comprises abnormalities in bone and mineral metabolism and/or extraskeletal calcification secondary to CKD pathophysiology [17], [18]. Renal osteodystrophy is the spectrum of histologic changes that occur in bone architecture of patients with CKD. The kidney is the primary site for phosphate excretion and 1-α-hydroxylation of vitamin D. CKD patients develop hyperphosphatemia as a result of inadequate 1,25 dihydroxy-vitamin D levels that

Cardiovascular risk

The increased cardiovascular risk associated with end-stage renal disease has been well established, and estimated cardiovascular mortality rates are 10- to 100-fold higher among dialysis patients than age- and sex-matched individuals in the general population [27]. The cardiovascular risk associated with renal impairment increases earlier in the course of kidney disease progression than was initially hypothesized. More specifically, there is evidence that even mild to moderate degrees of renal

Dyslipidemia

Dyslipidemia is a major risk factor for cardiovascular morbidity and mortality and is common among patients with CKD. Lipid profiles vary widely in these patients, reflecting the level of kidney function and the degree of proteinuria [43]. In general, the prevalence of hyperlipidemia increases as renal function declines, with the degree of hypertriglyceridemia and elevation of LDL cholesterol being proportional to the severity of renal impairment.

Several factors contribute to the development

Nutritional issues

As patients progress through the stages of CKD, nutritional requirements are altered and metabolism of protein, water, salt, potassium, and phosphorus are affected [50]. These changes lead to ineffective energy generation despite adequate intake of protein and carbohydrate substrates. In more extreme manifestations, these alterations in nutrient use cause “uremic malnutrition,” a syndrome that is distinct from malnutrition caused by inadequate nutrient intake. Both inadequate nutrient intake

Summary

Patients with CKD present several complex management issues to health care providers. The staging system introduced in 2002 by the National Kidney Foundation is a significant accomplishment, which stratifies patients according to disease severity. In addition, the K/DOQI guidelines are an excellent tool for management of CKD and dialysis patients and recommend treatments according to disease stage. These interventions may reduce morbidity and mortality in these patients. With early

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