Chronic Kidney Disease Overview

Definition of Chronic Kidney Disease (CKD)

• CKD is characterized by structural or functional kidney abnormalities lasting 3 months or longer.
• Structural abnormalities include:
  • Albuminuria >30 mg/day
  • Hematuria or red cell casts in urine sediment
  • Electrolyte imbalances
• Decreased Glomerular Filtration Rate (GFR) is indicative of functional impairment.

Classification and Etiology of CKD

• CKD can be categorized based on cause, duration, and GFR levels.
• Common etiologies: diabetes, hypertension, glomerulonephritis, and polycystic kidney disease.

Pathophysiology of CKD

• Progression is often associated with glomerulosclerosis, nephron loss, and interstitial fibrosis.
• Complications include fluid overload, metabolic acidosis, and electrolyte disturbances.

Clinical Manifestations of CKD

• Symptoms vary but may include:
  • Fatigue
  • Swelling in limbs
  • Changes in urine output
  • Bone pain due to mineral and bone disorder
  • Anemia

Diagnostic Tests for CKD

• Routine tests include:
  • Serum creatinine to calculate GFR
  • Urine test for protein, blood, and electrolytes
  • Imaging to assess kidney structure.

Treatment Goals

• Slow progression of kidney disease.
• Manage complications and comorbid conditions.
• Delay the need for dialysis or transplantation.

Treatment

• Pharmacological options vary based on specific complications:
  • Control hypertension and diabetes.
  • Phosphate binders for hyperphosphatemia.
• Nonpharmacological interventions include lifestyle modifications and dietary restrictions.

Dialysis in CKD

• Dialysis becomes necessary when GFR falls below critical thresholds, typically around 15 mL/min.
• Hemodialysis and peritoneal dialysis are the two primary methods.

Renal Transplant

• Considered for eligible patients when CKD progresses to end-stage renal disease (ESRD).
• Offers improved quality of life and survival compared to long-term dialysis.

Nonpharmacological Treatment

• Renal diet restrictions are crucial in the management of CKD.
• Hypertensive patients should adhere to a low-sodium diet.
• Emphasis on smoking cessation and limited alcohol intake (2 drinks/day for men, 1 for women).

Management of Hyperphosphatemia

• Oral calcium salts as the first line for severe hyperphosphatemia, binding phosphorus in the GI tract.
• Elemental calcium intake should not exceed 1500 mg/day.
• Phosphate-Binding Agents include:
  • Calcium Carbonate: 0.5-1g taken three times daily with meals.
  • Sevelamer HCl/Sevelamer carbonate: 800–1600 mg three times a day with meals.
  • Lanthanum Carbonate: 750–1500 mg/day, titrated up to 1000-3000 mg/day over time.