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Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
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Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
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Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area.
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Chronic Kidney Disease II: Clinical Manifestations01:24

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Chronic Kidney Disease (CKD) progressively impairs multiple body systems due to the accumulation of uremic toxins, which disrupt cellular functions across various organs.Neurologic symptomsNeurologic symptoms often arise early in CKD, as uremic toxin buildup drives changes in cognitive and motor functions. Patients frequently experience fatigue, headache, confusion, difficulty concentrating, and, in severe cases, seizures. Peripheral neuropathy commonly manifests as burning sensations in the...
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Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

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Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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Chronic Kidney Disease IV: Nursing Management01:18

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Nursing management is essential for preventing complications, maintaining stability, and improving patients' quality of life in chronic kidney disease (CKD). By using a structured approach, nurses help slow CKD progression and support effective patient care​.1. Comprehensive patient assessmentEffective management begins with nurses reviewing the patient’s medical history, and identifying key risk factors like diabetes, hypertension, and nephrotoxic drug use. Nurses assess signs of...
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Cause-Specific Deaths in Non-Dialysis-Dependent CKD.

Sankar D Navaneethan1, Jesse D Schold2, Susana Arrigain3

  • 1Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of CWRU, Cleveland, Ohio; and navanes@ccf.org.

Journal of the American Society of Nephrology : JASN
|June 6, 2015
PubMed
Summary

Chronic kidney disease (CKD) patients face higher mortality. Cardiovascular disease and cancer are leading causes of death, with declining kidney function increasing risks for both, particularly in Black patients.

Keywords:
cardiovascular diseasechronic kidney diseasemalignancymortality

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Area of Science:

  • Nephrology
  • Public Health
  • Epidemiology

Background:

  • Chronic kidney disease (CKD) is linked to increased mortality risk.
  • Specific causes of death in non-dialysis-dependent CKD patients require further elucidation.
  • Understanding cause-specific mortality is crucial for targeted interventions in CKD management.

Purpose of the Study:

  • To investigate the leading causes of death in a large, non-dialysis-dependent CKD population.
  • To analyze the association between declining estimated glomerular filtration rate (eGFR) and cause-specific mortality.
  • To examine racial differences in mortality causes among CKD patients.

Main Methods:

  • Utilized an electronic medical record-based CKD registry and Ohio Department of Health mortality files.
  • Included 33,478 white and 5042 Black patients with CKD (eGFR < 60 ml/min/1.73 m² on two occasions).
  • Classified causes of death (before end-stage renal disease) into cardiovascular, malignancy, and other categories.

Main Results:

  • Cardiovascular diseases (34.7%) and malignant neoplasms (31.8%) were the primary causes of death.
  • Malignancy-related deaths were more prevalent in earlier stages of CKD.
  • Each 5 ml/min/1.73 m² decline in eGFR correlated with increased risk of cardiovascular and non-cardiovascular/non-malignancy deaths, but not malignancy deaths. Black patients showed higher cardiovascular death risk compared to white patients.

Conclusions:

  • Cardiovascular disease and cancer are the dominant causes of mortality in non-dialysis CKD.
  • Declining kidney function significantly elevates the risk of cardiovascular and other non-malignancy deaths.
  • Targeting cardiovascular risk factors and cancer risk factors is essential for improving survival in CKD populations, with attention to racial disparities.