Chronic kidney disease
Chronic kidney disease | |
---|---|
Other names | Chronic renal disease, kidney failure, impaired kidney function |
Frequency | 753 million (2016)[1] |
Deaths | 1.2 million (2015)[6] |
Chronic kidney disease (CKD) is a type of
Causes of chronic kidney disease include
Screening at-risk people is recommended.
Chronic kidney disease affected 753 million people globally in 2016 (417 million females and 336 million males.)[1][21] In 2015, it caused 1.2 million deaths, up from 409,000 in 1990.[6][22] The causes that contribute to the greatest number of deaths are high blood pressure at 550,000, followed by diabetes at 418,000, and glomerulonephritis at 238,000.[6]
Signs and symptoms
CKD is initially without symptoms, and is usually detected on routine screening blood work by either an increase in serum creatinine, or protein in the urine. As the kidney function decreases, more unpleasant symptoms may emerge:[23]
- Blood pressure is increased due to fluid overload and production of vasoactive hormones created by the kidney via the renin–angiotensin system, increasing the risk of developing hypertension and heart failure. People with CKD are more likely than the general population to develop atherosclerosis with consequent cardiovascular disease, an effect that may be at least partly mediated by uremic toxins.[24][unreliable medical source?] People with both CKD and cardiovascular disease have significantly worse prognoses than those with only cardiovascular disease.[25]
- Urea accumulates, leading to azotemia and ultimately uremia (symptoms ranging from lethargy to pericarditis and encephalopathy). Due to its high systemic concentration, urea is excreted in eccrine sweat at high concentrations and crystallizes on skin as the sweat evaporates ("uremic frost").
- cardiac arrhythmias). Hyperkalemia usually does not develop until the glomerular filtration rate falls to less than 20–25 mL/min/1.73 m2, when the kidneys have decreased ability to excrete potassium. Hyperkalemia in CKD can be exacerbated by acidemia (triggering the cells to release potassium into the bloodstream to neutralize the acid) and from lack of insulin.[26]
- Fluid overload symptoms may range from mild edema to life-threatening pulmonary edema.
- Hyperphosphatemia results from poor phosphate elimination in the kidney, and contributes to increased cardiovascular risk by causing vascular calcification.[27] Circulating concentrations of fibroblast growth factor-23 (FGF-23) increase progressively as the kidney capacity for phosphate excretion declines, which may contribute to left ventricular hypertrophy and increased mortality in people with CKD .[28][29]
- 1,25 dihydroxyvitamin D3).[32] Later, this progresses to secondary hyperparathyroidism, kidney osteodystrophy, and vascular calcification that further impairs cardiac function. An extreme consequence is the occurrence of the rare condition named calciphylaxis.[33]
- Changes in mineral and bone metabolism that may cause 1) abnormalities of
- Metabolic acidosis may result from decreased capacity to generate enough ammonia from the cells of the proximal tubule.[26] Acidemia affects the function of enzymes and increases excitability of cardiac and neuronal membranes by the promotion of hyperkalemia.[34]
- Anemia is common and is especially prevalent in those requiring haemodialysis. It is multifactorial in cause, but includes increased inflammation, reduction in erythropoietin, and hyperuricemia leading to bone-marrow suppression. Hypoproliferative anemia occurs due to inadequate production of erythropoietin by the kidneys.[35]
- In later stages, cachexia may develop, leading to unintentional weight loss, muscle wasting, weakness, and anorexia.[36]
- Cognitive decline in patients experiencing CKD is an emerging symptom revealed in research literature.[37][38][39][40] Current research suggests that patients with CKD face a 35-40% higher likelihood of cognitive decline and or dementia.[37][38] This relation is dependent on the severity of CKD in each patient; although emerging literature indicates that patients at all stages of CKD will have a higher risk of developing these cognitive issues.[40][41][38]
- Sexual dysfunction is very common in both men and women with CKD. A majority of men have a reduced sex drive, difficulty obtaining an erection, and reaching orgasm, and the problems get worse with age. Most women have trouble with sexual arousal, and painful menstruation and problems with performing and enjoying sex are common.[42]
Causes
The three most common causes of CKD in order of frequency as of 2015 are
About one of five adults with hypertension and one of three adults with diabetes have CKD. If the cause is unknown, it is called idiopathic.[44]By anatomical location
- hemolytic-uremic syndrome, and vasculitis.
- Glomerular disease comprises a diverse group and is classified into:[citation needed]
- Primary glomerular disease such as focal segmental glomerulosclerosis and IgA nephropathy (or nephritis)
- Secondary glomerular disease such as diabetic nephropathy and lupus nephritis
- Tubulointerstitial disease includes drug- and toxin-induced chronic tubulointerstitial nephritis, and reflux nephropathy
- Obstructive nephropathy, as exemplified by bilateral pinwormsinfecting the kidney can cause obstructive nephropathy.
Other
- Genetic congenital disease such as polycystic kidney disease or 17q12 microdeletion syndrome.
- Mesoamerican nephropathy, is "a new form of kidney disease that could be called agricultural nephropathy".[45] A high and so-far unexplained number of new cases of CKD, referred to as the Mesoamerican nephropathy, has been noted among male workers in Central America, mainly in sugarcane fields in the lowlands of El Salvador and Nicaragua. Heat stress from long hours of piece-rate work at high average temperatures[46][47][48][49] of about 36 °C (96 °F) is suspected,[50] as are agricultural chemicals[51]
Diagnosis
Diagnosis of CKD is largely based on
Screening
Screening those who have neither symptoms nor risk factors for CKD is not recommended.[52][53] Those who should be screened include: those with hypertension or history of cardiovascular disease, those with diabetes or marked obesity, those aged > 60 years, subjects with African American ancestry, those with a history of kidney disease in the past, and subjects who have relatives who had kidney disease requiring dialysis.[citation needed]
Screening should include calculation of the estimated GFR (eGFR) from the serum creatinine level, and measurement of urine albumin-to-creatinine ratio (ACR) in a first-morning urine specimen (this reflects the amount of a protein called albumin in the urine), as well as a urine dipstick screen for hematuria.[54]
The GFRis derived from the serum creatinine and is proportional to 1/creatinine, i.e. it is a reciprocal relationship; the higher the creatinine, the lower the GFR. It reflects one aspect of kidney function, how efficiently the glomeruli - the filtering units - work. The normal GFR is 90-120 ml/min. The units of creatinine vary from country to country, but since the glomeruli make up <5% of the mass of the kidney, the GFR does not indicate all aspects of kidney health and function. This can be done by combining the GFR level with the clinical assessment of the person, including fluid status, and measuring the levels of hemoglobin, potassium, phosphate, and parathyroid hormone.[citation needed]
Ultrasound
Kidney ultrasonography is useful for diagnostic and prognostic purposes in chronic kidney disease. Whether the underlying pathologic change is glomerular sclerosis, tubular atrophy, interstitial fibrosis, or inflammation, the result is often increased echogenicity of the cortex. The echogenicity of the kidney should be related to the echogenicity of either the liver or the spleen (Figure 22 and Figure 23). Moreover, decreased kidney size and cortical thinning are also often seen and especially when disease progresses (Figure 24 and Figure 25). However, kidney size correlates to height, and short persons tend to have small kidneys; thus, kidney size as the only parameter is not reliable.[55]
-
Chronic renal disease caused by glomerulonephritis with increased echogenicity and reduced cortical thickness. Measurement of kidney length on the US image is illustrated by '+' and a dashed line.[55]
-
Nephrotic syndrome. Hyperechoic kidney without demarcation of cortex and medulla.[55]
-
Chronic pyelonephritis with reduced kidney size and focal cortical thinning. Measurement of kidney length on the US image is illustrated by '+' and a dashed line.[55]
-
End-stage chronic kidney disease with increased echogenicity, homogenous architecture without visible differentiation between parenchyma and renal sinus and reduced kidney size. Measurement of kidney length on the US image is illustrated by '+' and a dashed line.[55]
Additional imaging
Additional tests may include
Stages
Chronic kidney disease (CKD) staging - CKD G1-5 A1-3 albumin/creatinine ratio (ACR)
| ||||||
---|---|---|---|---|---|---|
ACR | ||||||
A1 | A2 | A3 | ||||
Normal to mildly increased | Moderately increased | Severely increased | ||||
<30 | 30–300 | >300 | ||||
G F R | ||||||
G1 | Normal | ≥ 90 | 1 if kidney damage present | 1 | 2 | |
G2 | Mildly decreased | 60–89 | 1 if kidney damage present | 1 | 2 | |
G3a | Mildly to moderately decreased | 45–59 | 1 | 2 | 3 | |
G3b | Moderately to severely decreased | 30–44 | 2 | 3 | 3 | |
G4 | Severely decreased | 15–29 | 3 | 4+ | 4+ | |
G5 | Kidney failure | <15 | 4+ | 4+ | 4+ | |
Numbers 1–4 indicates risk of progression as well as frequency of monitoring (number of times a year). Kidney Disease Improving Global Outcomes - KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease [57] |
A glomerular filtration rate (GFR) ≥ 60 mL/min/1.73 m2 is considered normal without chronic kidney disease if there is no kidney damage present.
Kidney damage is defined signs of damage seen in blood, urine, or imaging studies which includes lab albumin/creatinine ratio (ACR) ≥ 30.[58] All people with a GFR <60 mL/min/1.73 m2 for 3 months are defined as having chronic kidney disease.[58]
Protein in the urine is regarded as an independent marker for worsening of kidney function and cardiovascular disease. Hence, British guidelines append the letter "P" to the stage of chronic kidney disease if protein loss is significant.[59]
- Stage 1: Slightly diminished function; kidney damage with normal or relatively high GFR (≥90 mL/min/1.73 m2) and persistent albuminuria. Kidney damage is defined as pathological abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging studies.[58]
- Stage 2: Mild reduction in GFR (60–89 mL/min/1.73 m2) with kidney damage. Kidney damage is defined as pathological abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging studies.[58]
- Stage 3: Moderate reduction in GFR (30–59 mL/min/1.73 m2):.[58] British guidelines distinguish between stage 3A (GFR 45–59) and stage 3B (GFR 30–44) for purposes of screening and referral.[59]
- Stage 4: Severe reduction in GFR (15–29 mL/min/1.73 m2)[58] Preparation for kidney replacement therapy.
- Stage 5: Established kidney failure (GFR <15 mL/min/1.73 m2), permanent kidney replacement therapy,[58] or end-stage kidney disease.
The term "non-dialysis-dependent chronic kidney disease" (NDD-CKD) is a designation used to encompass the status of those persons with an established CKD who do not yet require the life-supporting treatments for kidney failure known as kidney replacement therapy (RRT, including maintenance dialysis or kidney transplantation). The condition of individuals with CKD, who require either of the two types of kidney replacement therapy (dialysis or transplant), is referred to as the end-stage kidney disease (ESKD). Hence, the start of the ESKD is practically the irreversible conclusion of the NDD-CKD. Even though the NDD-CKD status refers to the status of persons with earlier stages of CKD (stages 1 to 4), people with advanced stage of CKD (stage 5), who have not yet started kidney replacement therapy, are also referred to as NDD-CKD.
Management
Chronic kidney disease (CKD) is a serious condition often linked to diabetes and high blood pressure. There is no cure, but a combination of lifestyle changes and medications can help slow its progression. This might include a plant-dominant diet with less protein and salt, medications to control blood pressure and sugar, and potentially newer anti-inflammatory drugs. Doctors may also focus on managing heart disease risk, preventing infections, and avoiding further kidney damage. While dialysis may eventually be needed, a gradual transition can help preserve remaining kidney function. More research is ongoing to improve CKD management and patient outcomes.[60]
Blood pressure
Other measures
- Aggressive treatment of high blood lipids is recommended.[62]
- A low-protein, low-salt diet may result in slower progression of CKD and reduction in proteinuria as well as controlling symptoms of advanced CKD to delay dialysis start.[63] A tailored low-protein diet, designed for low acidity, may help prevent damage to kidneys for people with CKD.[64] Additionally, controlling salt ingestion helps to decrease the incidence of coronary heart disease, lowering blood pressure and reducing albuminuria.[65]
- Anemia – A target hemoglobin level of 100-120 g/L is recommended;[66][67] raising hemoglobin levels to the normal range has not been found to be of benefit.[68]
- Guidelines recommend treatment with parenteral iron prior to treatment with erythropoietin.
- Replacement of erythropoietin is often necessary in people with advanced disease.[69]
- It is unclear if androgens improve anemia.[70]
- Guidelines recommend treatment with
- Calcitriol is recommended for vitamin D deficiency and control of metabolic bone disease.
- Phosphate binders are used to control the serum phosphatelevels, which are usually elevated in advanced chronic kidney disease.
- Phosphodiesterase-5 inhibitors and zinc may improve sexual dysfunction in men.[42]
Lifestyle interventions
Weight loss
Obesity may have a negative impact in CKD, increasing the risk of disease progression to ESKD or kidney failure compared to controls with healthy weight,[71] and when in advanced stages also may hinder people's eligibility to kidney transplantation.[72] For example, the consumption of high calorie and high fructose beverages can make an individual "60% more likely to develop CKD".[73][74]
Weight management interventions in overweight and obese adults with CKD (of various stages) have been studied to assess its safety and efficacy. A recent systematic review[75] collected evidence from 17 studies which evaluated lifestyle (including dietary, physical activity/exercise, or behavioural strategies used in isolation or in combination), pharmacological (used to reduce absorption or suppress appetite) and surgical interventions. The review concluded that lifestyle interventions may provide some health benefits, namely improving body weight, low density lipoprotein (LDL) cholesterol and diastolic blood pressure (DBP), when compared to usual care or controls. Whether these benefits extend to help reducing cardiovascular events, kidney function and risk of death is uncertain. These conclusions were based on very low quality of evidence, so future robust studies are needed. Thus, it is recommended that weight management interventions should be individualised, according to a thorough patients' assessment regarding clinical condition, motivations and preferences.[citation needed]
Dietary salt intake
High dietary sodium intake may increase the risk of hypertension and cardiovascular disease. The effect of dietary restriction of salt in foods has been investigated in people with chronic kidney disease. A 2021
Omega-3 fatty acid supplementation
In people with CKD who require hemodialysis, there is a risk that
Protein supplementation
There is moderate-certainty evidence that regular consumption of oral protein-based nutritional supplements may increase serum albumin levels slightly in people with CKD, especially among those requiring hemodialysis or who are malnourished.
Iron supplementation
A Cochrane review of controlled trials comparing intravenous (IV) iron therapy with oral iron supplements, found low-certainty evidence that people receiving IV-iron treatment were 1.71 times as likely to reach their target hemoglobin levels.[79] Overall, hemoglobin was 0.71g/dl higher than those treated with oral iron supplements. Iron stores in the liver, estimated by serum ferritin, were also 224.84 µg/L higher in those receiving IV-iron.[79] However, there was also low-certainty evidence that allergic reactions were more likely following IV-iron therapy. It was unclear whether type of iron therapy administration affects the risk of death from any cause, including cardiovascular, nor whether it may alter the number of people who may require a blood transfusion or dialysis.[79]
Sleep
People with CKD experience sleep disorders, thus not being able to get quality sleep.[80] There are several strategies that could help, such as relaxation techniques, exercise, acupressure and medication:[80]
- Exercise: weak evidence demonstrates that exercise may be helpful with sleep regulation. Nevertheless, exercise possibly decreases fatigue and depression in people with CKD.[80]
- Acupressure: evidence suggests that this technique may have slight effects on latency and sleep duration, as well as on fatigue reduction, although these results are not reliable due to the diversity of conclusions in several articles.[80]
Despite all the available options studied so far, evidence shows that none of them is effective in the treatment of sleep disorders.[80] This means that we are not able to conclude which is the best guidance to improve sleep quality in this type of population.[80]
eHealth interventions
There is currently limited evidence suggesting that eHealth interventions may improve dietary sodium intake and fluid management for people with chronic kidney disease (CKD).[81] The findings are based on low certainty evidence of 43 studies. So, more large and higher quality research studies are needed to understand the impact of eHealth on the health of people with CKD.[81]
Referral to a nephrologist
Guidelines for referral to a nephrologist vary between countries. Most agree that nephrology referral is required by Stage 4 CKD (when eGFR/1.73m2 is less than 30 mL/min; or decreasing by more than 3 mL/min/year).[82]
It may also be useful at an earlier stage (e.g. CKD3) when urine albumin-to-creatinine ratio is more than 30 mg/mmol, when blood pressure is difficult to control, or when hematuria or other findings suggest either a primarily glomerular disorder or secondary disease amenable to specific treatment. Other benefits of early nephrology referral include proper education regarding options for kidney replacement therapy as well as pre-emptive transplantation, and timely workup and placement of an arteriovenous fistula in those people with chronic kidney disease opting for future hemodialysis.[citation needed]
Renal replacement therapy
At stage 5 CKD, kidney replacement therapy is usually required, in the form of either dialysis or a kidney transplant.
In CKD numerous uremic toxins accumulate in the blood. Even when ESKD (largely synonymous with CKD5) is treated with dialysis, the toxin levels do not go back to normal as dialysis is not that efficient. Similarly, after a kidney transplant, the levels may not go back to normal as the transplanted kidney may not work 100%. If it does, the creatinine level is often normal. The toxins show various cytotoxic activities in the serum and have different molecular weights, and some of them are bound to other proteins, primarily to albumin. Uremic toxins are classified into three groups as small water-soluble solutes, middle molecular-weight solutes, and protein-bound solutes.[83] Hemodialysis with high-flux dialysis membrane, long or frequent treatment, and increased blood/dialysate flow has improved removal of water-soluble small molecular weight uremic toxins. Middle molecular weight molecules are removed more effectively with hemodialysis using a high-flux membrane, hemodiafiltration and hemofiltration. However, conventional dialysis treatment is limited in its ability to remove protein-bound uremic toxins.[84]
Prognosis
CKD increases the risk of cardiovascular disease, and people with CKD often have other risk factors for heart disease, such as high blood lipids. The most common cause of death in people with CKD is cardiovascular disease rather than kidney failure.
Chronic kidney disease results in worse all-cause mortality (the overall death rate) which increases as kidney function decreases.[85] The leading cause of death in chronic kidney disease is cardiovascular disease, regardless of whether there is progression to stage 5.[85][86][87]
While kidney replacement therapies can maintain people indefinitely and prolong life, the quality of life is negatively affected.[88][89] Kidney transplantation increases the survival of people with stage 5 CKD when compared to other options;[90][91] however, it is associated with an increased short-term mortality due to complications of the surgery. Transplantation aside, high-intensity home hemodialysis appears to be associated with improved survival and a greater quality of life, when compared to the conventional three-times-a-week hemodialysis and peritoneal dialysis.[92]
People with ESKD are at increased overall risk for cancer.
In children, growth failure is a common complication from CKD. Children with CKD will be shorter than 97% of children the same age and sex. This can be treated with additional nutritional support, or medication such as Growth hormone[96]
Survival without dialysis
In a review from 2022 survival and quality of life was investigated in patients who had decided against dialysis treatment when reaching end-stage chronic kidney disease. 41 longitudinal studies (cohort studies) with a total of 5,102 patients were evaluated. The mean age of patients per study was 60 – 87 years. The mean estimated glomerular filtration rate (eGFR) at the time of decision per study was 7 – 19 ml/min pro 1,73 m2.
The median survival per study was:
- all 41 studies: 1 – 41 months
- studies from continental Europe (11 studies, 1.021 patients): 6 – 37 months
- studies from Asia (7 studies, 1.147 patients): 7 – 41 months
- age 70–79 years (9 studies, 607 patients): 7 – 41 months
- age 80+ (25 studies, 3.186 patients): 1 – 37 months
The longest survival times per study from the three studies with the highest median were 82, 79, and 75 months.
During the observation periods of 8 to 24 months mental well-being improved, and physical well-being and quality of life were largely stable until the late phase of the illness.
The authors of the review reached the following conclusion: “Our findings challenge the common misconception that the only alternative to dialysis for many patients with advanced CKD is no care or death.”[97][98]
In a review from 2021 25 studies were analyzed that had compared survival times and quality of life between patients with and without dialysis. Survival was generally longer with dialysis, but from the age of 80 and in elderly patients with comorbidities this effect became uncertain. Concerning quality of life there was a trend that patients without dialysis had an advantage.[99]
Epidemiology
About one in ten people have chronic kidney disease. In Canada 1.9 to 2.3 million people were estimated to have CKD in 2008.[68] CKD affected an estimated 16.8% of U.S. adults aged 20 years and older in the period from 1999 to 2004.[100] In 2007 8.8% of the population of Great Britain and Northern Ireland had symptomatic CKD.[101]
Chronic kidney disease was the cause of 956,000 deaths globally in 2013, up from 409,000 deaths in 1990.[22]
Chronic kidney disease of unknown aetiology
The cause of chronic kidney disease is in some cases not known; it is referred to as chronic kidney disease of unknown aetiology (CKDu). As of 2020[update] a rapidly progressive chronic kidney disease, unexplained by diabetes and hypertension, had increased dramatically in prevalence over a few decades in several regions in Central America and Mexico, a CKDu referred to as the Mesoamerican nephropathy (MeN). It was estimated in 2013 that at least 20,000 men had died prematurely, some in their 20s and 30s; a figure of 40,000 per year was estimated in 2020. In some affected areas CKD mortality was five times the national rate. MeN primarily affects men working as sugarcane labourers.[47] The cause is unknown, but in 2020 the science found a clearer connection between heavy labour in high temperatures and incidence of CKDu; improvements such as regular access to water, rest and shade, can significantly decrease the potential CKDu incidence.[102] CKDu also affects people in Sri Lanka where it is the eighth largest cause of in-hospital mortality.[103]
Race
African, Hispanics, and South Asians, particularly those from Pakistan, Sri Lanka, Bangladesh, and India, are at high risk of developing CKD. Africans are at greater risk due to the number of people affected with hypertension among them. As an example, 37% of ESKD cases in African Americans can be attributed to high blood pressure, compared with 19% among Caucasians.[7] Treatment efficacy also differs between racial groups. Administration of antihypertensive drugs generally halts disease progression in white populations but has little effect in slowing kidney disease among black people, and additional treatment such as bicarbonate therapy is often required.[7] While lower socioeconomic status contributes to the number of people affected with CKD, differences in the number of people affected by CKD are still evident between Africans and Whites when controlling for environmental factors.[7]
Although CKDu was first documented among sugar cane workers in Costa Rica in the 1970s, it may well have affected plantation labourers since the introduction of sugar cane farming to the Caribbean in the 1600s. In colonial times the death records of slaves on sugar plantations was much higher than for slaves forced into other labour.[102]
Society and culture
The International Society of Nephrology is an international body representing specialists in kidney diseases.
United States
- The National Kidney Foundation is a national organization representing people with chronic kidney diseases and professionals who treat kidney diseases.
- The American Kidney Fund is a national nonprofit organization providing treatment-related financial assistance to one of every five people undergoing dialysis each year.
- The Renal Support Network is a nonprofit, patient-focused, patient-run organization that provides non-medical services to those affected by CKD.
- The American Association of Kidney Patients is a nonprofit, patient-centric group focused on improving the health and well-being of CKD and people undergoing dialysis .
- The Renal Physicians Association is an association representing nephrology professionals.
United Kingdom
It was said to be costing the National Health Service about £1.5 billion a year in 2020.[104]
Australia
Kidney Health Australia serves that country.
Other animals
Dogs
The incidence rate of CKD in dogs was 15.8 cases per 10,000 dog years at risk. The mortality rate of CKD was 9.7 deaths per 10,000 dog years at risk. (rates developed from a population of 600,000 insured Swedish dogs; one dog year at risk is one dog at risk for one year)The breeds with the highest rates were the Bernese mountain dog, miniature schnauzer and boxer. The Swedish elkhound, Siberian husky and Finnish spitz were the breeds with the lowest rates.[105][106]
Cats
Cats with chronic kidney disease may have a buildup of waste products usually removed by the kidneys. They may appear lethargic, unkempt, and lose weight, and may have hypertension. The disease can prevent appropriate concentration of urine, causing cats to urinate greater volumes and drink more water to compensate. Loss of important proteins and vitamins through urine may cause abnormal metabolism and loss of appetite. The buildup of acids within blood can result in acidosis, which can lead to anemia, (which can sometimes be indicated by pink or whitish gums, but by no means does the presence of normal colored gums guarantee that anemia is not present or developing), and lethargy.[107]
Research
Currently[
References
- ^ PMID 29791905.
- ^ a b c d e "What Is Chronic Kidney Disease?". National Institute of Diabetes and Digestive and Kidney Diseases. June 2017. Retrieved 19 December 2017.
- ^ PMID 22919275.
- ^ a b "Kidney Failure". MedlinePlus. Retrieved 11 November 2017.
- ^ a b c d e "What is renal failure?". Johns Hopkins Medicine. Retrieved 18 December 2017.
- ^ PMID 27733281.
- ^ PMID 18443258.
- ^ a b c "Chronic Kidney Disease Tests & Diagnosis". National Institute of Diabetes and Digestive and Kidney Diseases. October 2016. Retrieved 19 December 2017.
- ^ a b "Kidney Failure". National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 11 November 2017.
- ^ a b c d e "Managing Chronic Kidney Disease". National Institute of Diabetes and Digestive and Kidney Diseases. October 2016.
- ^ a b c KDIGO: Kidney Disease Improving Global Outcomes (August 2009). "KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)" (PDF). Kidney Int. 76 (Suppl 113). Archived from the original (PDF) on 2016-12-13.
- PMID 15385656.
- PMID 25598998.
- ISBN 9780323529570.
- ^ PMID 26597926.
- PMID 22783025.
- PMID 24352797.
- ^ "Eating Right for Chronic Kidney Disease | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 5 September 2019.
- ^ "Anemia in Chronic Kidney Disease". National Institute of Diabetes and Digestive and Kidney Diseases. July 2016. Retrieved 19 December 2017.
- ^ "Mineral & Bone Disorder in Chronic Kidney Disease". National Institute of Diabetes and Digestive and Kidney Diseases. November 2015. Retrieved 19 December 2017.
- ^ PMID 36536732.
- ^ PMID 25530442. Table 2, p. 137
- S2CID 245636182.
- PMID 30592654.
- PMID 24164864.
- ^ a b Arora P, Aronoff GR, Mulloy LL, Talavera F, Verrelli M (2018-09-16). Batuman V (ed.). "Chronic Kidney Disease". Medscape.
- PMID 18449174.
- PMID 21985788.
- PMID 18687639.
- PMID 22886720.
- PMID 7967341.
- ISBN 978-0-07-174890-2.
- PMID 21337312.
- PMID 7025622.
- PMID 30969693. NBK539871.
- PMID 21475675.
- ^ PMID 35957738.
- ^ PMID 35061870.
- PMID 26919914.
- ^ S2CID 5248658.
- S2CID 23257233.
- ^ PMID 21154382.
- PMID 27733282.
- ^ "United States Renal Data System (USRDS)". Archived from the original on 2007-02-13.
- PMID 24878646.
- ^ Tangri N (29 July 2013). "MesoAmerican Nephropathy: A New Entity". eAJKD. National Kidney Foundation.
- ^ PMID 24028232.
- S2CID 20611337.
- PMID 24336030.
- ^ Grovern N (2021-10-21). "Global heating 'may lead to epidemic of kidney disease'". The Guardian. Archived from the original on 2021-10-21. Retrieved 2021-10-25.
- ^ Chavkin S, Greene R (12 December 2011). "Thousands of sugar cane workers die as wealthy nations stall on solutions". International Consortium of Investigative Journalists. Retrieved November 26, 2012.
- PMID 24145991.
- PMID 30305035.
- ISBN 978-1-58255-893-6.
- ^ PMID 26838799. (CC-BY 4.0)
- ^ "Kidney scans". Singlehealth.
- ^ CKD Evaluation and Management 2012. Kidney Disease Improving Global Outcomes (KDIGO). Retrieved 2019-07-06.
- ^ a b c d e f g National Kidney Foundation (2002). "K/DOQI clinical practice guidelines for chronic kidney disease". Archived from the original on 2005-04-15. Retrieved 2008-06-29.
- ^ National Institute for Health and Clinical Excellence. Clinical guideline 73: Chronic kidney disease. London, 2008.
- S2CID 235631509.
- PMID 28873137.
- S2CID 22730176.
- S2CID 27499763.
- PMID 28117137.
- PMID 34164803.
- PMID 20591813.
- PMID 19546410.
- ^ PMID 19015566.
- ^ "Anaemia management in people with chronic kidney disease (CG114)". NICE Clinical Guideline. UK National Institute for Health and Care Excellence. February 2011.
- PMID 25300168.
- PMID 24998954.
- PMID 27190330.
- PMID 32174139.
- S2CID 19747921.
- PMID 33782940.
- ^ PMID 34164803.
- ^ PMID 30480758.
- ^ PMID 32390133.
- ^ PMID 30790278.
- ^ PMID 31129916.
- ^ PMID 31425608.
- ^ "CKD Stage 4". davita.
- PMID 12675874.
- .
- ^ S2CID 22569162.
- PMID 14581387.
- PMID 16738019.
- )
- S2CID 6826119.
- S2CID 11725547.
- PMID 15715116.
- S2CID 9807935.
- ^ S2CID 24527420.
- ^ American Society of Nephrology. "Five Things Physicians and Patients Should Question" (PDF). Choosing Wisely: An Initiative of the ABIM Foundation. Retrieved August 17, 2012.
- PMID 8651845.
- ^ "Growth Failure in Children with Chronic Kidney Disease | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 2022-12-09.
- PMID 35285915.)
{{cite journal}}
: CS1 maint: multiple names: authors list (link - , PMID 35285925.
- PMID 34507554.)
{{cite journal}}
: CS1 maint: multiple names: authors list (link - PMID 17332726.
- ^ Morgan T (21 January 2009). "Chronic Kidney Disease (stages 3–5) prevalence estimates using data from the Neoerica study (2007)". Association of Public Health Observatories. Archived from the original on 18 July 2011. Retrieved 4 March 2010.
- ^ a b Hodal K (27 November 2020). "The mystery epidemic striking Nicaragua's sugar cane workers – a photo essay". The Guardian.
- PMID 31194108.
- ^ Trueland J (20 March 2020). "Tackling the £1.5bn a year cost of chronic kidney disease". Health Service Journal. Southfields, Essex, UK: Wilmington Healthcare Limited. Retrieved 16 May 2020.
- ISBN 978-91-7760-208-8. Retrieved 8 June 2018.
- S2CID 25622105.
- ^ "Chronic Kidney Disease". Cornell University College of Veterinary Medicine. 2017-10-16. Retrieved 2023-06-12.
- ^ Clinical trial number NCT00151827 for "Olmesartan Medoxomil in Hypertension and Renal Impairment" at ClinicalTrials.gov
- ^ Ogbru O (20 December 2019). Marks JW (ed.). "Angiotensin II Receptor Blockers (ARBs)". MedicineNet.
External links
- Dialysis Complications of Chronic Renal Failure at eMedicine
- Chronic Renal Failure Information Archived 2013-03-15 at the Wayback Machine from Great Ormond Street Hospital
- [./Https://www.mybestpdf.com/world-diabetes-day-2022/ How to Prevent Chronic Kidney Disease n World Diabetes Day 2022]