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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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Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
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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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Acute Kidney Injury III: Clinical Manifestations01:29

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Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
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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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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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[Renal function performance in CKD stage 5: a sealed fate?]

Daniela Cecilia Cannarile1, Matteo De Liberali1, Rossella Gaggi1

  • 1U.O. Nefrologia, Dialisi, Ipertensione. IRCCS Azienda Ospedaliero-Universitaria di Bologna. Bologna, Italia.

Giornale Italiano Di Nefrologia : Organo Ufficiale Della Societa Italiana Di Nefrologia
|February 18, 2021
PubMed
Summary

Chronic kidney disease (CKD) stage 5 progression is often slow, with most patients showing stabilization or improvement rather than rapid decline. Peripheral obliterative arteriopathy is linked to faster kidney function loss in CKD stage 5 patients.

Keywords:
CKDchronic kidney diseasechronic renal failuredisease progressionglomerular filtrate

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Area of Science:

  • Nephrology
  • Internal Medicine

Background:

  • Chronic kidney disease (CKD) stages 4 and 5 are traditionally viewed as rapidly progressive.
  • Understanding the evolution of kidney function in advanced CKD is crucial for patient management.

Purpose of the Study:

  • To retrospectively analyze the kidney function evolution in patients with CKD stage 5.
  • To identify clinical and laboratory factors associated with different rates of estimated glomerular filtration rate (eGFR) progression.

Main Methods:

  • Retrospective evaluation of CKD stage 5 patients with >6 months follow-up and at least 4 clinical-laboratory controls.
  • Assessment of agreement between measured creatinine clearance (ClCr) and CKD-EPI estimated GFR (eGFR) using Bland-Altman analysis.
  • Classification of eGFR progression rates: fast (>5 ml/min/year), slow (1-5 ml/min/year), and non-progressive (<1 ml/min/year or increase).
  • Bivariate and multinomial multiple regression analyses to identify associated clinical-laboratory parameters.

Main Results:

  • Good agreement between measured ClCr and eGFR, particularly for GFR <12 ml/min.
  • Average eGFR slope was -3.05 ml/min/year.
  • Fast progression (>5 ml/min/year) observed in 17% of patients; slow progression in 57.6%; non-progressive in 25.4%.
  • Peripheral obliterative arteriopathy (POA) was significantly associated with fast eGFR progression (RR=5.97) in multivariable analysis.

Conclusions:

  • The majority of CKD stage 5 patients in this cohort experienced slow progression, stabilization, or improvement of kidney function.
  • CKD stage 5 may not always represent an inexorable rapid decline towards end-stage renal disease.
  • Peripheral obliterative arteriopathy is a key factor associated with accelerated eGFR decline in advanced CKD.