10 quick CKD facts – for doctors and nurses
These 10 quick facts about CKD, mainly for renal doctors, nurses, AHPs pharmacists and other health professionals. These largely relate to more advanced stages (CKD3B-CKD5).
So. What are 10 quick CKD facts – for doctors and nurses?
- Common causes of chronic kidney disease (CKD) – are diabetes, renovascular disease, polycystic kidney disease (PCKD), tubulointerstitial disease and glomerulonephritis. However ‘unknown with small kidneys’ is the commonest ’cause’
“Even though CKD affects 10% of the population, 1 in 100 will require dialysis or a kidney transplant. Your job is to spot them and try to prevent it”
- CKD is not a diagnosis. It is a syndrome (a pattern of disease) with 7 groups of causes (above). You need to determine the precise underlying cause – or tissue diagnosis – as this affects the treatment
“What is the tissue diagnosis?”
- Distinguish from AKI. It is important to distinguish CKD from acute kidney injury (AKI, rapid onset kidney failure). This is quite easy. Patients with AKI look and feel very unwell and the underlying cause (e.g. infection and dehydration) dominates the illness. Patients with CKD usually look well, tired but well. Blood tests will confirm which it is
- Effects of CKD – include: high blood pressure; high potassium (hyperkalaemia); renal bone disease (low blood calcium, hypocalcaemia; high phosphate, hyperphosphataemia); metabolic acidosis; and anaemia (lack of red blood cells). You need to monitor and treat these parameters
- Treat fluid overload (with diuretics, sometimes at high dosage), and hyperkalaemia first
- Control underlying disorders – especially BP (and keep under 130/80; usually starting with an ACE inhibitor or ARB) and diabetes
- Treat patients with proteinuric CKD – with an ACE inhibitor (e.g. Ramipril) or ARB (Losartan), plus an SGLT2 inhibitor (Dapagliflozin)
- Treat renal bone disease (with alfacalcidol), anaemia (EPO) and acidosis (sodium bicarbonate) – and restrict sodium, potassium and phosphate, if needed. This is usually needed at the CKD4 stage
- Educate patients with advanced CKD early (late CKD3B or early CKD4) – on treatment options (dialysis, kidney transplantation, or supportive care), to allow adequate time for planning
- Prepare for dialysis (and/or kidney transplantation, or supportive care) during early-to-mid stage 4 CKD; to allow adequate time for patient education and selection of treatment modality, along with any associated preparatory procedures (e.g. fistula creation).
“Helping the patient get their BP under 130/80 all the time, is the single most useful thing you can do for them”
When to initiate dialysis for patients in CKD5 (kidney failure)
When symptoms are inadequately controlled with drugs and lifestyle interventions. When is this? ..
“If the blood creatinine is over 500 mcmol/L or eGFR under 10 mls/min, or urea over 40 mmol/L, ask yourself, why hasn’t dialysis been started?”
Summary
We have described 10 quick CKD facts – for doctors and nurses. We hope it has been helpful.
Last Reviewed on 4 April 2024