Chronic Kidney Disease

Abstract

Chronic kidney disease (CKD) is a clinical syndrome secondary to the definitive change in function and/or structure of the kidney and is characterized by its irreversibility and slow and progressive evolution. Another important aspect is the pathology represents a higher risk of complications and mortality, especially cardiovascular-related 1. An adult patient is identified with CKD when they present, for a period equal to or greater than three months, glomerular filtration rate (GFR) lower than 60 ml/min/1.73 m 2 , or GFR greater than 60 ml/min/1.73 m 2 , but with evidence of injury of the renal structure. Some indicators of renal injury are albuminuria, changes in renal imaging, hematuria/ leukocyturia, persistent hydroelectrolytic disorders, histological changes in kidney biopsy, and previous kidney transplantation 1. Albuminuria is defined by the presence of more than 30 mg of albumin in the 24-hour urine or more than 30 mg/g of albumin in an isolated urine sample adjusted by urinary creatinine. The main causes of CKD include diabetes, hypertension, chronic glomerulonephritis, chronic pyelonephritis, chronic use of anti-inflammatory medication, autoimmune diseases, polycystic kidney disease, Alport disease, congenital malformations, and prolonged acute renal disease. SUMMARY Chronic kidney disease is highly prevalent (10-13% of the population), irreversible, progressive, and associated with higher cardiovascular risk. Patients with this pathology remain asymptomatic most of the time, presenting the complications typical of renal dysfunction only in more advanced stages. Its treatment can be conservative (patients without indication for dialysis, usually those with glomerular filtration rate above 15 ml/minute) or replacement therapy (hemodialysis, peritoneal dialysis, and kidney transplantation). The objectives of the conservative treatment for chronic kidney disease are to slow down the progression of kidney dysfunction, treat complications (anemia, bone diseases, cardiovascular diseases), vaccination for hepatitis B, and preparation for kidney replacement therapy.

Association of Air Pollutants with Incident Chronic Kidney Disease in a Nationally Representative Cohort of Korean Adults

“…Chronic kidney disease (CKD) is an irreversible and progressive disease with high prevalence globally [1]. In 2017, 697.5 million people were diagnosed with CKD, and 1.2 million people died due to CKD [2].…”

“…However, there remains further comprehensive confirmation on association of long-term exposure to O 3 , which is a primary oxidant of photochemical smog that has extrapulmonary effects to the blood, central nervous system, spleen, and other organs [14]. CKD develops when attributed by the repetitive renal inflammation that leads to unsuccessful filtering of the blood [1]. Moreover, the kidneys are especially vulnerable to air pollution exposure, considering about 20% of the cardiac output of blood is conveyed to the kidneys, where most environmental toxins would be settled during filtration [6].…”

Automatic Reminder for Fluids Management on Confidence and Compliance with Fluid Restrictions in Hemodialysis Patients

“…Endstage chronic kidney disease is a progressive and irreversible loss of kidney function and inability to maintain metabolic, fluid and electrolyte balance, resulting in uremia [1]. The most common renal function replacement therapy in patients with kidney failure is hemodialysis [2] and its success is influenced by patient's adherence to therapy, restrictions on fluid intake, diet, treatment and control schedules [3].…”

“…The prevalence of patients with end-stage kidney failure in the world is as many as 661,648 people and poses a global health threat. In Indonesia, the number of kidney failure patients is around 0.2% and as many as 98% of patients undergo hemodialysis therapy [1,4]. The level of noncompliance with hemodialysis patients in limiting fluid intake reaches 79.5% in America, Germany, Belgium and Ireland [6].…”

Pharmacoeconomic evaluation of chronic kidney disease patients: a study on cost of illness

“…The Kidney Disease: Improving Global Outcomes (KDIGO) started in 2003, with a aim to improve care and outcomes of kidney disease patients worldwide by promoting, coordination, collaboration, and integration of initiatives. KDIGO is managed by the National Kidney Foundation (NKF) [4].…”