Chronic kidney disease

870: 839: 885: 1585:, 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. 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. 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. 1478:

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. 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.

855: 363: 1569:(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. 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. CKDu also affects people in 760: 2672: 47: 1607:

disparities. This approach fails to account for the complex interplay of genetic, environmental, and social factors influencing kidney function. Depending solely on race-based metrics may lead to misdiagnosis or underdiagnosis in minority populations. Alternative approaches that consider socioeconomic status, environmental exposures, and genetic vulnerability, are needed to accurately assess kidney function and address CKD care disparities.

803:(AKI) is important because AKI can be reversible. One diagnostic clue that helps differentiate CKD from AKI is a gradual rise in serum creatinine (over several months or years) as opposed to a sudden increase in the serum creatinine (several days to weeks). In many people with CKD, previous kidney disease or other underlying diseases are already known. A significant number present with CKD of unknown cause. 820:

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.

1349:) and surgical interventions. Any of these can help people with CKD loose weight, however, it is not known if they can also prevent death or cardiovascular events like heart complications or stroke. It is recommended that weight management interventions should be individualised, according to a thorough patients' assessment regarding clinical condition, motivations and preferences. 884: 1190:

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.

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delayed diagnosis. Structural barriers, such as lack of insurance and limited healthcare facilities, hinder access to timely care. Furthermore, health insurance coverage disparities, with minority populations lacking adequate coverage, contribute to these disparities. Denial of care worsens health outcomes and perpetuates existing health inequities.

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related to the echogenicity of either the liver or the spleen. Moreover, decreased kidney size and cortical thinning are also often seen and especially when disease progresses. However, kidney size correlates to height, and short persons tend to have small kidneys; thus, kidney size as the only parameter is not reliable.

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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.

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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. CKD affected an estimated 16.8% of U.S. adults aged 20 years and older in the period from 1999 to 2004. In 2007 8.8% of the population of Great Britain and Northern Ireland had

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People with CKD experience sleep disorders, thus unable to get quality sleep. There are several strategies that could help, such as relaxation techniques, exercise, and medication. Exercise may be helpful with sleep regulation and possibly decreases fatigue and depression in people with CKD. However,

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The GFR is 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.

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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

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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

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People who had decide against dialysis treatment when reaching end-stage chronic kidney disease could survive several years and experience improvements in their mental well-being in addition to sustained physical well-being and overall quality of life until late in their illness course. However, use

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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

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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 a rapidly progressive chronic kidney disease, unexplained by diabetes and hypertension, had increased dramatically in prevalence over a few decades in

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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

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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

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Screening those who have neither symptoms nor risk factors for CKD is not recommended. 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

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Cognitive decline in patients experiencing CKD is an emerging symptom revealed in research literature. Research suggests that patients with CKD face a 35–40% higher likelihood of cognitive decline and or dementia. This relation is dependent on the severity of CKD in each patient; although emerging

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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. For people with CKD, including those on dialysis, reduced salt intake may help to lower both

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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

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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

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Denial of care in chronic kidney disease treatment and management is a significant issue for minority populations. This can be due to healthcare provider bias, structural barriers, and health insurance coverage disparities. Healthcare provider biases can lead to under-treatment, misdiagnosis, or

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Survival rates of CKD are generally longer with dialysis than without (having only conservative kidney management). However, from the age of 80 and in elderly patients with comorbidities there is no difference in survival between the two groups. Quality of life might be better for people without

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Chronic kidney disease affected 753 million people globally in 2016 (417 million females and 336 million males.) In 2015, it caused 1.2 million deaths, up from 409,000 in 1990. The causes that contribute to the greatest number of deaths are high blood pressure at 550,000, followed by diabetes at

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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. A tailored low-protein diet, designed for low acidity, may help prevent damage to kidneys for people with CKD. Additionally,

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Race-based kidney function metrics, particularly normalizing creatinine, pose ethical challenges in diagnosing and managing chronic kidney disease (CKD). While certain racial and ethnic groups are at higher risk, using race as a reference range may reinforce stereotypes and perpetuate health

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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

1217:, and death from cardiovascular disease when compared to placebo in individuals with CKD. ACEIs may be superior to ARBs for protection against progression to kidney failure and death from any cause in those with CKD. Aggressive blood pressure lowering decreases people's risk of death. 1504:

is negatively affected. Kidney transplantation increases the survival of people with stage 5 CKD when compared to other options; however, it is associated with an increased short-term mortality due to complications of the surgery. Transplantation aside, high-intensity

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Stage 1: Slightly diminished function; kidney damage with normal or relatively high GFR (≥90 mL/min/1.73 m) and persistent albuminuria. Kidney damage is defined as pathological abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging

1205:(ARBs) are recommended as first-line agents since they have been found to slow the decline of kidney function, relative to a more rapid decline in those not on one of these agents. They have also been found to reduce the risk of major cardiovascular events such as 1180:

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.

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level and mid-arm muscle circumference may also be increased following supplementation. Despite possible improvement in these indicators of nutritional status, it is not certain that protein supplements affect quality of life, life expectancy, inflammation or

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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

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falls to less than 20–25 mL/min/1.73 m, 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

5329:"Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention" 4791:

Cheungpasitporn W, Thongprayoon C, O'Corragain OA, Edmonds PJ, Kittanamongkolchai W, Erickson SB (December 2014). "Associations of sugar-sweetened and artificially sweetened soda with chronic kidney disease: a systematic review and meta-analysis".

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Kidney damage is defined signs of damage seen in blood, urine, or imaging studies which includes lab albumin/creatinine ratio (ACR) ≥ 30. All people with a GFR <60 mL/min/1.73 m for 3 months are defined as having chronic kidney disease.

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should be avoided. Other recommended measures include staying active, and certain dietary changes such as a low-salt diet and the right amount of protein. Treatments for anemia and bone disease may also be required. Severe disease requires

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Vecchio M, Navaneethan SD, Johnson DW, Lucisano G, Graziano G, Saglimbene V, et al. (Cochrane Kidney and Transplant Group) (December 2010). "Interventions for treating sexual dysfunction in patients with chronic kidney disease".

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Guidelines for referral to a nephrologist vary between countries. Most agree that nephrology referral is required by Stage 4 CKD (when eGFR/1.73m is less than 30 mL/min; or decreasing by more than 3 mL/min/year).

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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

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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.

1497:(the overall death rate) which increases as kidney function decreases. The leading cause of death in chronic kidney disease is cardiovascular disease, regardless of whether there is progression to stage 5. 1151:

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

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Kalantar-Zadeh K, Lockwood MB, Rhee CM, Tantisattamo E, Andreoli S, Balducci A, Laffin P, Harris T, Knight R, Kumaraswami L, Liakopoulos V, Lui SF, Kumar S, Ng M, Saadi G, Ulasi I, Tong A, Li PK (Jan 3, 2022).

1772:, 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. 1137:

Stage 2: Mild reduction in GFR (60–89 mL/min/1.73 m) with kidney damage. Kidney damage is defined as pathological abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging

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and reduced kidney mass) and the skeletal resistance to the calcemic action of parathyroid hormone. Osteocytes are responsible for the increased production of FGF-23, which is a potent inhibitor of the enzyme

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O'Lone E, Connors M, Masson P, Wu S, Kelly PJ, Gillespie D, et al. (June 2016). "Cognition in People With End-Stage Kidney Disease Treated With Hemodialysis: A Systematic Review and Meta-analysis".

4450:"Target haemoglobin to aim for with erythropoiesis-stimulating agents: a position statement by ERBP following publication of the Trial to reduce cardiovascular events with Aranesp therapy (TREAT) study" 2013:"Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015" 5621:

Maisonneuve P, Agodoa L, Gellert R, Stewart JH, Buccianti G, Lowenfels AB, et al. (July 1999). "Cancer in patients on dialysis for end-stage renal disease: an international collaborative study".

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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.

3543:"Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015" 404:, an effect that may be at least partly mediated by uremic toxins. People with both CKD and cardiovascular disease have significantly worse prognoses than those with only cardiovascular disease. 1523:

recommend that physicians do not perform routine cancer screening in people with limited life expectancies due to ESKD because evidence does not show that such tests lead to improved outcomes.

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none of these options have been proven to be effective in the treatment of sleep disorders. This means that it is unknown what is the best guidance to improve sleep quality in this population.

4654:"The dose-response relationship between body mass index and the risk of incident stage ≥3 chronic kidney disease in a general japanese population: the Ibaraki prefectural health study (IPHS)" 3847: 2630:"Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013" 854: 6145: 485:(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 . 1141:

Stage 3: Moderate reduction in GFR (30–59 mL/min/1.73 m):. British guidelines distinguish between stage 3A (GFR 45–59) and stage 3B (GFR 30–44) for purposes of screening and referral.

4221:"Association Between More Intensive vs Less Intensive Blood Pressure Lowering and Risk of Mortality in Chronic Kidney Disease Stages 3 to 5: A Systematic Review and Meta-analysis" 2210: 1366:

and associated symptoms, such as dizziness, with lower salt intake. The effect of salt restriction on extracellular fluid, oedema, and total body weight reduction is not known.

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from the cells of the proximal tubule. Acidemia affects the function of enzymes and increases excitability of cardiac and neuronal membranes by the promotion of hyperkalemia.

2449:"2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8)" 4491:"The impact of selecting a high hemoglobin target level on health-related quality of life for patients with chronic kidney disease: a systematic review and meta-analysis" 5731: 2069:"Long-term effects of renin-angiotensin system-blocking therapy and a low blood pressure goal on progression of hypertensive chronic kidney disease in African Americans" 481:

results from poor phosphate elimination in the kidney, and contributes to increased cardiovascular risk by causing vascular calcification. Circulating concentrations of

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occurs over a period of months to years, or abnormal kidney structure (with normal function). Initially generally no symptoms are seen, but later symptoms may include

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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

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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

2367:"Renin-Angiotensin System Inhibitors and Kidney and Cardiovascular Outcomes in Patients With CKD: A Bayesian Network Meta-analysis of Randomized Clinical Trials" 735:, is "a new form of kidney disease that could be called agricultural nephropathy". A high and so-far unexplained number of new cases of CKD, referred to as the 4150: 4170: 563: 2211:"KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)" 582:

is common and is especially prevalent in those requiring haemodialysis. It is multifactorial in cause, but includes increased inflammation, reduction in

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People with ESKD are at increased overall risk for cancer. This risk is particularly high in younger people and gradually diminishes with age. Medical

430:). Due to its high systemic concentration, urea is excreted in eccrine sweat at high concentrations and crystallizes on skin as the sweat evaporates (" 586:, and hyperuricemia leading to bone-marrow suppression. Hypoproliferative anemia occurs due to inadequate production of erythropoietin by the kidneys. 6038: 1509:

appears to be associated with improved survival and a greater quality of life, when compared to the conventional three-times-a-week hemodialysis and

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Anemia – A target hemoglobin level of 100–120 g/L is recommended; raising hemoglobin levels to the normal range has not been found to be of benefit.

3896:"Screening, monitoring, and treatment of stage 1 to 3 chronic kidney disease: A clinical practice guideline from the American College of Physicians" 5869: 5806: 3839: 4744:"High-fructose corn syrup-sweetened soft drink consumption increases vascular resistance in the kidneys at rest and during sympathetic activation" 3541:

Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (GBD 2015 Disease Injury Incidence Prevalence Collaborators) (October 2016).

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with increased echogenicity and reduced cortical thickness. Measurement of kidney length on the US image is illustrated by '+' and a dashed line.

329:(ARBs) are generally first-line agents for blood pressure control, as they slow progression of the kidney disease and the risk of heart disease. 1812:"Disparities in Chronic Kidney Disease Prevalence among Males and Females in 195 Countries: Analysis of the Global Burden of Disease 2016 Study" 1644:

is a national nonprofit organization providing treatment-related financial assistance to one of every five people undergoing dialysis each year.

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A glomerular filtration rate (GFR) ≥ 60 mL/min/1.73 m is considered normal without chronic kidney disease if there is no kidney damage present.

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Kidney Disease Improving Global Outcomes – KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease

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Conley MM, McFarlane CM, Johnson DW, Kelly JT, Campbell KL, MacLaughlin HL, et al. (Cochrane Kidney and Transplant Group) (March 2021).

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Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. (GBD 2015 Mortality Causes of Death Collaborators) (October 2016).

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with reduced kidney size and focal cortical thinning. Measurement of kidney length on the US image is illustrated by '+' and a dashed line.

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Screening at-risk people is recommended. Initial treatments may include medications to lower blood pressure, blood sugar, and cholesterol.

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Naghavi M, Wang H, Lozano R, Davis A, Liang X, Zhou M, et al. (GBD 2013 Mortality and Causes of Death Collaborators) (January 2015).

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of acute care services in these cases is common and intensity of end-of-life care is highly variable among people opting out of dialysis.

3937:"Diagnosis and management of non-dialysis chronic kidney disease in ambulatory care: a systematic review of clinical practice guidelines" 2121: 523:, and vascular calcification that further impairs cardiac function. An extreme consequence is the occurrence of the rare condition named 2225: 5091:

O'Lone EL, Hodson EM, Nistor I, Bolignano D, Webster AC, Craig JC, et al. (Cochrane Kidney and Transplant Group) (February 2019).

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controlling salt ingestion helps to decrease the incidence of coronary heart disease, lowering blood pressure and reducing albuminuria.

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Mah JY, Choy SW, Roberts MA, Desai AM, Corken M, Gwini SM, McMahon LP, et al. (Cochrane Kidney and Transplant Group) (May 2020).

747:. Heat stress from long hours of piece-rate work at high average temperatures of about 36 °C (96 °F) is suspected, as are 6395: 636:. About one of five adults with hypertension and one of three adults with diabetes have CKD. If the cause is unknown, it is called 504: 2186: 1147:

Stage 5: Established kidney failure (GFR <15 mL/min/1.73 m), permanent kidney replacement therapy, or end-stage kidney disease.

6708: 5990:"CKD of Unknown Etiology (CKDu) in Sri Lanka: A Multilevel Clinical Case Definition for Surveillance and Epidemiological Studies" 5940: 4703:"Obesity and the risk of cardiovascular and all-cause mortality in chronic kidney disease: a systematic review and meta-analysis" 1198: 322: 2521: 1780:

As of 2019 several compounds are in development for the treatment of CKD. These include the angiotensin receptor blocker (ARB)

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CKD increases the risk of cardiovascular disease, and people with CKD often have other risk factors for heart disease, such as

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Chertow GM, Paltiel AD, Owen WF, Lazarus JM (June 1996). "Cost-effectiveness of cancer screening in end-stage renal disease".

5668: 6075: 5426: 3999: 3698:"The epidemic of chronic kidney disease of unknown etiology in Mesoamerica: a call for interdisciplinary research and action" 3093: 5757:"Does conservative kidney management offer a quantity or quality of life benefit compared to dialysis? A systematic review" 5189: 4988:

Tam KW, Wu MY, Siddiqui FJ, Chan ES, Zhu Y, Jafar TH, et al. (Cochrane Kidney and Transplant Group) (November 2018).

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Johnson RJ, Sánchez-Lozada LG (October 2013). "Chronic kidney disease: Mesoamerican nephropathy--new clues to the cause".

2578:"Osteoblastogenesis of adipose-derived mesenchymal stem cells in chronic kidney disease patient with regular hemodialysis" 6791: 5044:"Oral protein-based supplements versus placebo or no treatment for people with chronic kidney disease requiring dialysis" 4079: 3158:

Adrogué HJ, Madias NE (September 1981). "Changes in plasma potassium concentration during acute acid-base disturbances".

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with a history of kidney disease in the past, and subjects who have relatives who had kidney disease requiring dialysis.

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is a national organization representing people with chronic kidney diseases and professionals who treat kidney diseases.

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McMahon EJ, Campbell KL, Bauer JD, Mudge DW, Kelly JT, et al. (Cochrane Kidney and Transplant Group) (June 2021).

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Singh-Manoux A, Oumarou-Ibrahim A, Machado-Fragua MD, Dumurgier J, Brunner EJ, Kivimaki M, et al. (January 2022).

3274:"Vitamin K Status and Cognitive Function in Adults with Chronic Kidney Disease: The Chronic Renal Insufficiency Cohort" 1396:

molecules that reduce clotting, it does not have any impact on the prevention of vascular blockage in people with CKD.

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is a nonprofit, patient-focused, patient-run organization that provides non-medical services to those affected by CKD.

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literature indicates that patients at all stages of CKD will have a higher risk of developing these cognitive issues.

5822:"Long-term Outcomes Among Patients With Advanced Kidney Disease Who Forgo Maintenance Dialysis: A Systematic Review" 373:

CKD is initially without symptoms, and is usually detected on routine screening blood work by either an increase in

3328:"Association between kidney function and incidence of dementia: 10-year follow-up of the Whitehall II cohort study" 2786:"Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis" 1658:

is a nonprofit, patient-centric group focused on improving the health and well-being of CKD and people undergoing

362: 299: 6446: 6635: 5664: 5250:"Removal of uremic toxins by renal replacement therapies: a review of current progress and future perspectives" 4268:

Chauhan V, Vaid M (November 2009). "Dyslipidemia in chronic kidney disease: managing a high-risk combination".

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compared to controls with healthy weight, and when in advanced stages also may hinder people's eligibility to

1168:). The condition of individuals with CKD, who require either of the two types of kidney replacement therapy ( 611:, and reaching orgasm, and the problems get worse with age. Most women have trouble with sexual arousal, and 6451: 2152: 1693: 657: 516: 3633: 6388: 1666: 726: 704: 244: 3463:

Kurella M, Chertow GM, Luan J, Yaffe K (November 2004). "Cognitive impairment in chronic kidney disease".

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James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. (February 2014).

1490:. The most common cause of death in people with CKD is cardiovascular disease rather than kidney failure. 1176:), is referred to as the end-stage kidney disease (ESKD). Hence, the start of the ESKD is practically the 6701: 6422: 2996:"Fibroblast growth factor 23 inhibits extrarenal synthesis of 1,25-dihydroxyvitamin D in human monocytes" 1556:

Chronic kidney disease was the cause of 956,000 deaths globally in 2013, up from 409,000 deaths in 1990.

499: 482: 5536:

Giri M (2004). "Choice of renal replacement therapy in patients with diabetic end stage renal disease".

4360:"Reducing the Dietary Acid Load: How a More Alkaline Diet Benefits Patients With Chronic Kidney Disease" 3674: 6511: 4448:

Locatelli F, Aljama P, Canaud B, Covic A, De Francisco A, Macdougall IC, et al. (September 2010).

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Numbers 1–4 indicates risk of progression as well as frequency of monitoring (number of times a year).

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may be performed to determine the underlying cause. Several severity-based staging systems are in use.

239:. Complications can relate to hormonal dysfunction of the kidneys and include (in chronological order) 5284:

Perazella MA, Khan S (March 2006). "Increased mortality in chronic kidney disease: a call to action".

3789:

Roncal Jimenez CA, Ishimoto T, Lanaspa MA, Rivard CJ, Nakagawa T, Ejaz AA, et al. (August 2014).

739:, has been noted among male workers in Central America, mainly in sugarcane fields in the lowlands of 693:

Tubulointerstitial disease includes drug- and toxin-induced chronic tubulointerstitial nephritis, and

6546: 1463: 1421: 1157: 722: 508: 291: 184: 139: 5941:"Chronic Kidney Disease (stages 3–5) prevalence estimates using data from the Neoerica study (2007)" 2829: 2671: 6812: 6647: 6541: 6310: 4990:"Omega-3 fatty acids for dialysis vascular access outcomes in patients with chronic kidney disease" 3614: 1566: 1320: 935: 736: 732: 492: 5819: 1144:

Stage 4: Severe reduction in GFR (15–29 mL/min/1.73 m) Preparation for kidney replacement therapy.

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Yamamoto S, Kazama JJ, Wakamatsu T, Takahashi Y, Kaneko Y, Goto S, Narita I (14 September 2016).

4840:"Interventions for weight loss in people with chronic kidney disease who are overweight or obese" 1683: 909: 100: 5754: 5450:

de Francisco AL, Piñera C (January 2006). "Challenges and future of renal replacement therapy".

5327:

Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. (October 2003).

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Vanholder R, De Smet R, Glorieux G, Argilés A, Baurmeister U, Brunet P, et al. (May 2003).

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Chapman CL, Grigoryan T, Vargas NT, Reed EL, Kueck PJ, Pietrafesa LD, et al. (April 2020).

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Orantes CM, Herrera R, Almaguer M, Brizuela EG, Núñez L, Alvarado NP, et al. (April 2014).

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Bacchetta J, Sea JL, Chun RF, Lisse TS, Wesseling-Perry K, Gales B, et al. (January 2013).

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Gutiérrez OM, Mannstadt M, Isakova T, Rauh-Hain JA, Tamez H, Shah A, et al. (August 2008).

6817: 6694: 6501: 6493: 6458: 6441: 1316: 1267: 1165: 875: 579: 555: 401: 272: 256: 151: 105: 6350: 4096: 2332: 6610: 6531: 6268: 5863: 5800: 4939:

Stevenson JK, Campbell ZC, Webster AC, Chow CK, Tong A, Craig JC, et al. (August 2019).

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Weckmann GF, Stracke S, Haase A, Spallek J, Ludwig F, Angelow A, et al. (October 2018).

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While kidney replacement therapies can maintain people indefinitely and prolong life, the

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interventions may improve dietary sodium intake and fluid management for people with CKD.

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may develop, leading to unintentional weight loss, muscle wasting, weakness, and anorexia.

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Groothoff JW (July 2005). "Long-term outcomes of children with end-stage renal disease".

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may have a negative impact in CKD, increasing the risk of disease progression to ESKD or

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4629: 4604: 2688:"Patient-centred approaches for the management of unpleasant symptoms in kidney disease" 374: 6673: 6630: 6176: 6127: 6014: 5989: 5846: 5821: 5783: 5756: 5646: 5600: 5549: 5518: 5475: 5345: 5328: 5309: 5166: 5141: 5117: 5092: 5068: 5043: 5014: 4989: 4965: 4940: 4916: 4891: 4864: 4839: 4817: 4768: 4743: 4678: 4653: 4562: 4537: 4425: 4400: 4340: 4293: 4245: 4220: 4201: 4053: 4026: 3963: 3936: 3815: 3790: 3771: 3722: 3697: 3567: 3542: 3488: 3445: 3352: 3327: 3298: 3273: 3272:

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levels. However, allergic reactions may also be more likely following IV-iron therapy.

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to confirm blood flow and establish the differential function between the two kidneys.

860: 845: 694: 633: 600: 569: 449: 287: 135: 71: 6298: 5944: 5895: 5837: 5755:

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2752: 2645: 2028: 6717: 6476: 6321: 6119: 6100:"Incidence of and mortality from kidney disease in over 600,000 insured Swedish dogs" 6071: 6019: 5921: 5851: 5788: 5713: 5638: 5592: 5588: 5553: 5510: 5467: 5463: 5432: 5422: 5391: 5350: 5301: 5297: 5230: 5225: 5208: 5171: 5122: 5073: 5019: 4970: 4921: 4869: 4809: 4773: 4724: 4683: 4634: 4567: 4512: 4471: 4430: 4381: 4332: 4285: 4250: 4205: 4193: 4058: 3995: 3968: 3917: 3820: 3763: 3727: 3655: 3572: 3523: 3480: 3476: 3437: 3393: 3357: 3303: 3251: 3220:

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Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M, et al. (July 2006).

5340: 5293: 5261: 5220: 5161: 5157: 5153: 5112: 5108: 5104: 5063: 5059: 5055: 5009: 5005: 5001: 4960: 4956: 4952: 4911: 4907: 4903: 4859: 4855: 4851: 4801: 4763: 4755: 4714: 4673: 4665: 4624: 4620: 4616: 4557: 4549: 4507: 4502: 4490: 4461: 4420: 4416: 4412: 4371: 4324: 4277: 4240: 4232: 4185: 4048: 4038: 3958: 3948: 3907: 3810: 3802: 3755: 3717: 3709: 3696:

Wesseling C, Crowe J, Hogstedt C, Jakobsson K, Lucas R, Wegman DH (November 2013).

3645: 3562: 3554: 3519: 3515: 3472: 3449: 3427: 3385: 3347: 3339: 3293: 3285: 3241: 3233: 3167: 3118: 3056: 3045:"The calcemic response to PTH in the rat: effect of elevated PTH levels and uremia" 3015: 3007: 2966: 2958: 2917: 2909: 2868: 2860: 2797: 2756: 2748: 2699: 2649: 2641: 2597: 2589: 2468: 2464: 2460: 2419: 2378: 2303: 2295: 2255: 2088: 2080: 2032: 2024: 1912: 1902: 1823: 1410: 902: 311: 294:. Risk factors include a family history of chronic kidney disease. Diagnosis is by 6171: 6099: 3325: 2947:"Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis" 6315: 6228: 6098:

Pelander L, Ljungvall I, Egenvall A, Syme H, Elliott J, Häggström J (June 2015).

5142:"Interventions for improving sleep quality in people with chronic kidney disease" 4790: 1659: 1501: 1467: 1425: 1247:

Replacement of erythropoietin is often necessary in people with advanced disease.

1237: 1169: 1161: 912:(DMSA) scans are also used in kidney imaging; with both MAG3 and DMSA being used 784: 686: 675: 472: 397: 268: 224: 4759: 3194: 603:

is very common in both men and women with CKD. A majority of men have a reduced

6775: 6758: 6663: 6536: 6506: 6412: 6404: 6326: 6005: 5773: 4099:

2012. Kidney Disease Improving Global Outcomes (KDIGO). Retrieved 2019-07-06.

4067: 4043: 3389: 2802: 2785: 2704: 2687: 2593: 2383: 2366: 2208: 2084: 1743: 1689: 1528: 1487: 1312: 1241: 1153: 792: 583: 427: 385: 264: 220: 46: 17: 5971:"The mystery epidemic striking Nicaragua's sugar cane workers – a photo essay" 5506: 5266: 5249: 4376: 4359: 4169:

Kalantar-Zadeh, K; Jafar, TH; Nitsch, D; Neuen, BL; Perkovic, V (2021-06-24).

3953: 3414:

Bugnicourt JM, Godefroy O, Chillon JM, Choukroun G, Massy ZA (February 2013).

3237: 6806: 6741: 6731: 6642: 6577: 4281: 3713: 3650: 3343: 1943: 1747: 1214: 917: 551: 524: 464: 393: 330: 315: 6283: 5907: 4312: 3759: 2424: 2407: 1345:, or behavioural strategies), pharmacological (used to reduce absorption or 16:

This article is about CKD in general. For the end-stage of the disease, see

6668: 6658: 6620: 6123: 6023: 5925: 5855: 5792: 5642: 5596: 5557: 5514: 5471: 5436: 5395: 5386: 5354: 5305: 5234: 5175: 5126: 5077: 5023: 4974: 4925: 4873: 4813: 4777: 4728: 4687: 4669: 4638: 4571: 4533: 4516: 4475: 4434: 4385: 4336: 4289: 4254: 4197: 4062: 3972: 3921: 3870:"Thousands of sugar cane workers die as wealthy nations stall on solutions" 3824: 3767: 3731: 3659: 3576: 3527: 3484: 3441: 3432: 3415: 3397: 3361: 3307: 3255: 3206: 3130: 3029: 2980: 2931: 2882: 2811: 2770: 2713: 2663: 2611: 2482: 2433: 2392: 2365:

Xie X, Liu Y, Perkovic V, Li X, Ninomiya T, Hou W, et al. (May 2016).

2317: 2269: 2102: 2046: 1926: 1837: 768: 764: 748: 700: 629: 612: 488: 441: 431: 423: 389: 366: 343: 240: 6251: 5717: 4328: 3416:"Cognitive disorders and dementia in CKD: the neglected kidney-brain axis" 3289: 3179: 3070: 2962: 2299: 1907: 530:

Changes in mineral and bone metabolism that may cause 1) abnormalities of

183:

Medications to manage blood pressure, blood sugar, and lower cholesterol,

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several regions in Central America and Mexico, a CKDu referred to as the

1385: 1363: 1359: 1125: 740: 396:. People with CKD are more likely than the general population to develop 381:. As the kidney function decreases, more unpleasant symptoms may emerge: 378: 295: 228: 173: 169: 146: 85: 4553: 4155: 3806: 3061: 3044: 2864: 1739: 5987: 5140:

Natale P, Ruospo M, Saglimbene VM, Palmer SC, Strippoli GF (May 2019).

4489:

Clement FM, Klarenbach S, Tonelli M, Johnson JA, Manns BJ (June 2009).

3894:

Qaseem A, Hopkins RH, Sweet DE, Starkey M, Shekelle P (December 2013).

1785: 1670: 1429: 1405: 1393: 1330: 1259: 796: 763:

A 12-lead ECG of a person with CKD and a severe electrolyte imbalance:

661: 535: 303: 64: 6115: 5418: 4805: 4592:. UK National Institute for Health and Care Excellence. February 2011. 3987: 3011: 2823: 2821: 2684: 2571: 2569: 1828: 1624:

is an international body representing specialists in kidney diseases.

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levels, which are usually elevated in advanced chronic kidney disease.

6751: 6572: 6567: 6356: 6216: 2913: 1346: 1277: 913: 905: 744: 667:

Glomerular disease comprises a diverse group and is classified into:

547: 539: 437: 236: 93: 6065: 5988:

Wijewickrama ES, Gunawardena N, Jayasinghe S, Herath C (June 2019).

4892:"Altered dietary salt intake for people with chronic kidney disease" 4585: 4401:"Altered dietary salt intake for people with chronic kidney disease" 3084:

Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J (2012).

1811: 6175:

for "Olmesartan Medoxomil in Hypertension and Renal Impairment" at

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McMahon EJ, Campbell KL, Bauer JD, Mudge DW, Kelly JT (June 2021).

3788: 2818: 2566: 1769: 1582: 1342: 1323:

beverages can make an individual "60% more likely to develop CKD".

1251: 708: 649: 590: 419: 411: 232: 89: 5409:

Heidenheim AP, Kooistra MP, Lindsay RM (2004). "Quality of life".

4586:"Anaemia management in people with chronic kidney disease (CG114)" 3413: 2944: 1788:, a mixture of low molecular weight heparin and dermatan sulfate. 1380:

In people with CKD who require hemodialysis, there is a risk that

1337:

adults with CKD include lifestyle inverventions (dietary changes,

6373: 3791:"Fructokinase activity mediates dehydration-induced renal injury" 3508: 2242:

Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY (September 2004).

1369: 1334: 1308: 573: 531: 458: 445: 307: 54:

Illustration of a kidney from a person with chronic renal failure

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Conservative Care for Kidney Failure-The Other Side of the Coin.

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