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Interesting Facts of Chronic kidney disease (CKD)
1. Chronic kidney disease is defined as the presence of kidney damage or decreased kidney function (defined as eGFR <60 mL/min per 1.73 m 2 ) for 3 or more months, irrespective of the cause.
2. Albuminuria is a risk factor for the development of ESKD in the general population, and a powerful predictor of kidney outcomes in Chronic kidney disease patients, with prognosis being worse with higher levels of albuminuria.
3. The leading causes of Chronic kidney disease are diabetes, hypertension, glomerulonephritis, and cystic kidney disease, with about 40% of all Chronic kidney disease due to diabetes.
4. Risk factors for Chronic kidney disease include diabetes, hypertension, cardiovascular disease, structural kidney tract disease, multisystem diseases with potential kidney involvement such as SLE, family history of kidney failure, hereditary kidney disease, and smoking.
5. Chronic kidney disease (CKD) progression can be monitored using serum creatinine and urine protein excretion.
6. Proteinuria is an important surrogate outcome for disease activity in someone with progressive kidney disease. In a patient with glomerular kidney disease, the level of proteinuria correlates with disease activity and potential risk for progression. Proteinuria can be reduced with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers; however, several studies have shown that these drugs should not be used in combination due to an increased risk of adverse events.
7. Although hemoglobin A1c is a sufficient marker of blood sugar control in a patient with early stages of kidney disease, it has limited utility in patients with stage 5 disease. Studies suggest little correlation between average blood glucose level and hemoglobin A1c in CKD stage 5 due to nonenzymatic glycosylation of hemoglobin and shortened red blood half-life.
8. Patients with progressive CKD should be educated about treatment options, including conservative care, hemodialysis, peritoneal dialysis, and transplantation.
9. In patients with metabolic acidosis, treatment with oral bicarbonate may slow progression of CKD, improve bone health, and nutritional status.
What is the definition of chronic kidney disease (CKD)
Chronic kidney disease (CKD) is defined as the presence of kidney damage or decreased kidney function (defined as estimated glomerular filtration rate [eGFR] <60 mL/min per 1.73 m 2 ) for 3 or more months, irrespective of the cause.
The persistence for at least 3 months is necessary to distinguish Chronic kidney disease from acute kidney injury (AKI). Markers of kidney damage include:
• Albuminuria with albumin to creatinine ratio (ACR) ≥30 mg/g
• Urine sediment abnormalities
• Electrolyte abnormalities due to tubular disorders
• Abnormalities detected by histology
• Structural abnormalities detected by imaging
• History of kidney transplantation
How is this definition of CKD derived?
This definition is derived from the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease.
For this definition, eGFR is calculated from serum creatinine using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.
Those with eGFR <60 mL/min per 1.73m 2 are considered to have reduced kidney function. Urinary albumin is assessed from the ACR, with four levels of ACR considered: <10 mg/g, 10 to <30 mg/g (normal to slightly elevated), 30 to 300 mg/g (moderately increased), and >300 mg/g (severely increased).
