# Chronic Kidney Disease --- **Chronic kidney disease** or **CKD** is an umbrella term that describes someone with progressive, irreversible [[kidneys|kidney]] damage and decreased kidney function. People with CKD have a lower [[glomerular filtration#Glomerular Filtration Rate & Net Filtration Pressure|glomerular filtration rate]]. A lot of people do not know that they have CKD, because our bodies are really good at compensating. So it's insidious, and it builds up slowly in the background. Untreated CKD can result lead to chronic kidney failure (CKF) and even end-stage kidney disease (ESKD). ## Risk Factors The biggest risk factors for developing chronic kidney disease are uncontrolled [[diabetes mellitus]] and [[hypertension]]—these account for 70% of CKD cases. Other risk factors include - heart problems - obesity - family history (remember SDOH) - [[smoking]]/tobacco use - age ## Signs & Symptoms The signs and symptoms of chronic kidney disease are varied. Because the kidneys affect every system, we can see anything from fatigue to sexual dysfunction, to joint pain and muscle spasms. ## Complications CKD can lead to [[hyperparathyroidism]] because our kidneys waste [[calcium]], which is sensed by the [[thyroid|parathyroid]] and causes it to secrete PTH. This increases calcium levels but it also increases [[phosphate]] reabsorption. ## Diagnostic Tests So it's defined as either the presence of kidney damage or a glomerular filtration rate of less than 60mL/minute per minute for three months or longer. ![[CKD stages.png]] And this is staged. You can see here on this chart, stage one you actually have an OK GFR. So you have mild kidney damage, but your kidneys are working as well as normal. In stage 2, sometimes referred to as renal insufficiency,  pts start becoming more symptomatic - you can tell that there's damage (maybe slightly elevated creatinine, or blood and/or protein in the urine).  The pt might have s/s, including HTN or anemia (check those lab values) but GFR is ok – not great, but OK. In stage 3, we start referring to renal failure.  This is when GFR drops below 60 and pts have more s/s of anemia (2/2 the drop in EPO production).  We’ll see worsening labs – creatinine and BUN, pts will be more symptomatic with fatigue, fluid retention, changes in urine color (darker, maybe tea-colored) and muscle cramping 2/2 e-lyte imbalances. In stage four, we're preparing for dialysis because our kidneys are not keeping up with waste excretion and we're having severe problems.  This is where we’ll see hyperK+, hyperPO4, metabolic acidosis, fatigue, nausea, bone pain…pts are pretty miserable with all they s/s that go along with these things. And then stage five, which really is true renal failure, where there’s total loss of renal function.  Severe s/s 2/2 uremia are present, and supplemental care like kidney dialysis is necessary to sustain life. So if we look at the bigger picture with this chart, you may or may not have any signs or symptoms at the top stages, one, two and three.  When we start getting to three, four and five, we’ll start seeing some symptoms.  Three is kind of a transitional stage, and pts in stage 3 are going to be watched very carefully.   It's really important that we are teaching our patients what this means and how to protect their kidneys - staying hydrated, watching for signs and symptoms of infection, preventing stones, anything that's going to irritate or cause further damage to the kidneys.  We’ll look closely at their meds to make sure there are no nephrotoxic drugs that they’re taking. ## Treatment Treatment for chronic kidney disease depends on the stage of the kidney damage. It often involves different dietary changes as well as avoiding nephrotoxic meds. ## Nursing Considerations - Patients with CKD should be on a reduced sodium diet to help decrease fluid retention and electrolyte imbalances. However, caution against using salt-substitutes, as often these are made from potassium chloride, and with poorly functioning kidneys this can lead to [[hyperkalemia]]. - Protein is another tricky diet modification CKD patients have. Too much protein is bad for the kidneys, but we also don't want to risk malnutrition, so each individual's ideal protein intake will vary. ___