Chronic kidney disease (CKD), also known as
chronic renal disease, is a progressive loss of
renal functionThe kidneys are paired organs, which have the production of urine as their primary function. Kidneys are seen in many types of animals, including vertebrates and some invertebrates. They are part of the urinary system, but have several secondary functions concerned with homeostatic functions. ...
over a period of months or years. The symptoms of worsening kidney function are unspecific, and might include feeling
generally unwellMalaise is a feeling of general discomfort or uneasiness, an "out of sorts" feeling, often the first indication of an infection or other disease...
and experiencing a
reduced appetiteAnorexia is the decreased sensation of appetite...
. Often, chronic kidney disease is diagnosed as a result of
screeningScreening, in medicine, is a strategy used in a population to detect a disease in individuals without signs or symptoms of that disease. Unlike most medicine, in screening, tests are performed on those without any clinical indication of disease....
of people known to be at risk of kidney problems, such as those with
high blood pressureHypertension is a chronic medical condition in which the blood pressure is elevated. It is also referred to as high blood pressure or shortened to HT, HTN or HPN. The word "hypertension", by itself, normally refers to systemic, arterial hypertension.Hypertension can be classified as either...
or
diabetesDiabetes mellitus —often referred to simply as diabetes—is a condition in which the body either does not produce enough, or does not properly respond to, insulin, a hormone produced in the pancreas. Insulin enables cells to absorb glucose in order to turn it into energy...
and those with a blood relative with chronic kidney disease. Chronic kidney disease may also be identified when it leads to one of its recognized complications, such as
cardiovascular diseaseCardiovascular disease or cardiovascular diseases is the class of diseases that involve the heart or blood vessels ....
,
anemiaAnemia is a decrease in normal number of red blood cells or less than the normal quantity of hemoglobin in the blood...
or
pericarditisPericarditis is an inflammation of the pericardium .-Classification:Pericarditis can be classified according to the composition of the inflammatory exudate.Types include:* serous* purulent* fibrinous...
.
Chronic kidney disease is identified by a
blood testA blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick....
for
creatinineCreatinine is a break-down product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body ....
. Higher levels of creatinine indicate a falling glomerular filtration rate and as a result a decreased capability of the kidneys to excrete waste products. Creatinine levels may be normal in the early stages of CKD, and the condition is discovered if
urinalysisA urinalysis is an array of tests performed on urine and one of the most common methods of medical diagnosis. A part of a urinalysis can be performed by using urine dipsticks, in which the test results can be read as color changes....
(testing of a urine sample) shows that the kidney is allowing the loss of
proteinProteins are organic compounds made of amino acids arranged in a linear chain and folded into a globular form. The amino acids in a polymer chain are joined together by the peptide bonds between the carboxyl and amino groups of adjacent amino acid residues...
or
red blood cellRed blood cells are the most common type of blood cell and the vertebrate body's principal means of delivering oxygen to the body tissues via the blood. They take up oxygen in the lungs or gills and release it while squeezing through the body's capillaries. The cells are filled with hemoglobin, a...
s into the urine. To fully investigate the underlying cause of kidney damage, various forms of
medical imagingMedical imaging refers to the techniques and processes used to create images of the human body for clinical purposes or medical science .As a discipline and in its widest sense, it is part of biological imaging and incorporates...
, blood tests and often renal
biopsyA biopsy is a medical test involving the removal of cells or tissues for examination. It is the removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
(removing a small sample of kidney tissue) are employed to find out if there is a reversible cause for the kidney malfunction. Recent professional guidelines classify the severity of chronic kidney disease in five stages, with stage 1 being the mildest and usually causing few symptoms and stage 5 being a severe illness with poor life expectancy if untreated. Stage 5 CKD is also called
established chronic kidney disease and is synonymous with the now outdated terms
end-stage renal disease (ESRD),
chronic kidney failure (CKF) or
chronic renal failure (CRF).
There is no specific treatment unequivocally shown to slow the worsening of chronic kidney disease. If there is an underlying cause to CKD, such as
vasculitisVasculitis refers to a heterogeneous group of disorders that are characterized by inflammatory destruction of blood vessels.Both arteries and veins are affected. Lymphangitis is sometimes considered a type of vasculitis....
, this may be treated directly with treatments aimed to slow the damage. In more advanced stages, treatments may be required for anemia and
bone diseaseRenal osteodystrophy or chronic kidney disease-mineral and bone disorder is a bone pathology, characterized by bone mineralization deficiency, that is a direct result of the electrolyte and endocrine derangements which accompany chronic kidney disease...
. Severe CKD requires one of the forms of
renal replacement therapyRenal replacement therapy is a term used to encompass life-supporting treatments for renal failure.It includes:*hemodialysis,*peritoneal dialysis,*hemofiltration and*renal transplantation....
; this may be a form of
dialysisIn medicine, dialysis is primarily used to provide an artificial replacement for lost kidney function due to renal failure...
, but ideally constitutes a
kidney transplantKidney transplantation or renal transplantation is the organ transplant of a kidney in a patient with end-stage renal disease. Kidney transplantation is typically classified as deceased-donor or living-donor transplantation depending on the source of the recipient organ...
.
Signs and symptoms
Initially it is without specific symptoms and can only be detected as an increase in serum
creatinineCreatinine is a break-down product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body ....
or protein in the urine. As the
kidneyThe kidneys are paired organs, which have the production of urine as their primary function. Kidneys are seen in many types of animals, including vertebrates and some invertebrates. They are part of the urinary system, but have several secondary functions concerned with homeostatic functions. ...
function decreases:
- blood pressure
Blood pressure is the pressure exerted by circulating blood on the walls of blood vessels, and is one of the principal vital signs. During each heartbeat, BP varies between a maximum and a minimum pressure...
is increased due to fluid overload and production of vasoactive hormones, increasing one's risk of developing hypertensionHypertension is a chronic medical condition in which the blood pressure is elevated. It is also referred to as high blood pressure or shortened to HT, HTN or HPN. The word "hypertension", by itself, normally refers to systemic, arterial hypertension.Hypertension can be classified as either...
and/or suffering from congestive heart failureHeart failure is a condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs...
- Urea
Urea or carbamide is an organic compound with the chemical formula
2CO. The molecule has two amine residues joined by a carbonyl functional group....
accumulates, leading to azotemiaAzotemia is a medical condition characterized by abnormal levels of nitrogen-containing compounds, such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds in the blood...
and ultimately uremiaUremia or uraemia is a term used to loosely describe the illness accompanying kidney failure , in particular the nitrogenous waste products associated with the failure of this organ....
(symptoms ranging from lethargy to pericarditisPericarditis is an inflammation of the pericardium .-Classification:Pericarditis can be classified according to the composition of the inflammatory exudate.Types include:* serous* purulent* fibrinous...
and encephalopathyEncephalopathy /ɛnˌsɛfəˈlɒpəθi/ literally means disorder or disease of the brain. In modern usage, encephalopathy does not refer to a single disease, but rather to a syndrome of global brain dysfunction; this syndrome can be caused by many different illnesses.-Terminology:In some contexts it...
). Urea is excreted by sweating and crystallizes on skin ("uremic frost").
- Potassium
Potassium is the chemical element with the symbol K , atomic number 19, and atomic mass 39.0983. Potassium was first isolated from potash...
accumulates in the blood (known as hyperkalemiaHyperkalemia is an elevated blood level of the electrolyte potassium. Extreme hyperkalemia is a medical emergency due to the risk of potentially fatal abnormal heart rhythms ....
with a range of symptoms including malaiseMalaise is a feeling of general discomfort or uneasiness, an "out of sorts" feeling, often the first indication of an infection or other disease...
and potentially fatal cardiac arrhythmiaCardiac arrhythmia is a term for any of a large and heterogeneous group of conditions in which there is abnormal electrical activity in the heart. The heart beat may be too fast or too slow, and may be regular or irregular....
s)
- Erythropoietin
Erythropoietin, or its alternative erythropoetin or EPO, is a glycoprotein hormone that controls erythropoiesis, or red blood cell production...
synthesis is decreased (potentially leading to anemiaAnemia is a decrease in normal number of red blood cells or less than the normal quantity of hemoglobin in the blood...
, which causes fatigueFatigue is a state of awareness. It can describe a range of afflictions, varying from a general state of lethargy to a specific work-induced burning sensation within one's muscles. It can be both physical and mental...
)
- Fluid volume overload
Fluid balance is the concept of human homeostasis that the amount of fluid lost from the body is equal to the amount of fluid taken in. Euvolemia is the state of normal body fluid volume.Water is necessary for all life on Earth...
- symptoms may range from mild edemaEdema or oedema , formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin, or in one or more cavities of the body...
to life-threatening pulmonary edemaPulmonary edema , or oedema , is fluid accumulation in the lungs. It leads to impaired gas exchange and may cause respiratory failure. It is due to either failure of the heart to remove fluid from the lung circulation or a direct injury to the lung parenchyma...
- Hyperphosphatemia
Hyperphosphatemia is an electrolyte disturbance in which there is an abnormally elevated level of phosphate in the blood. Often, calcium levels are lowered due to precipitation of phosphate with the calcium in tissues.-Causes:...
- due to reduced phosphate excretion, associated with hypocalcemia (due to vitamin D3 deficiency). The major sign of hypocalcemia being tetanyTetany is a medical sign, the involuntary contraction of muscles, caused by diseases and other conditions that increase the action potential frequency...
.
- Later this progresses to tertiary hyperparathyroidism
Tertiary hyperparathyroidism is a state of excessive secretion of parathyroid hormone after a long period of secondary hyperparathyroidism and resulting in hypercalcemia....
, with hypercalcaemiaHypercalcaemia is an elevated calcium level in the blood. . It can be an asymptomatic laboratory finding, but because an elevated calcium level is often indicative of other diseases, a diagnosis should be undertaken if it persists...
, renal osteodystrophyRenal osteodystrophy or chronic kidney disease-mineral and bone disorder is a bone pathology, characterized by bone mineralization deficiency, that is a direct result of the electrolyte and endocrine derangements which accompany chronic kidney disease...
and vascular calcification that further impairs cardiac function.
- Metabolic acidosis
In medicine, metabolic acidosis is a process which if unchecked leads to acidemia, i.e. blood pH is low due to increased production of H+ by the body or the inability of the body to form bicarbonate in the kidney. Its causes are diverse, and its consequences can be serious, including...
, due to accumulation of sulfates, phosphates, uric acid etc. This may cause altered enzyme activity by excess acid acting on enzymes and also increased excitability of cardiac and neuronal membranes by the promotion of hyperkalemiaHyperkalemia is an elevated blood level of the electrolyte potassium. Extreme hyperkalemia is a medical emergency due to the risk of potentially fatal abnormal heart rhythms ....
due to excess acid (acidemia)
People with chronic kidney disease suffer from accelerated
atherosclerosisAtherosclerosis is the condition in which an artery wall thickens as the result of a build-up of fatty materials such as cholesterol...
and are more likely to develop
cardiovascular diseaseCardiovascular disease or cardiovascular diseases is the class of diseases that involve the heart or blood vessels ....
than the general population. Patients afflicted with chronic kidney disease and cardiovascular disease tend to have significantly worse prognoses than those suffering only from the latter.
Diagnosis
In many CKD patients, previous renal disease or other underlying diseases are already known. A small number presents with CKD of unknown cause. In these patients, a cause is occasionally identified retrospectively.
It is important to differentiate CKD from
acute renal failureAcute renal failure , also known as acute kidney failure or acute kidney injury, is a rapid loss of renal function due to damage to the kidneys, resulting in retention of nitrogenous and non-nitrogenous waste products that are normally excreted by the kidney...
(ARF) because ARF can be reversible. Abdominal
ultrasoundDiagnostic sonography is an ultrasound-based diagnostic imaging technique used to visualize subcutaneous body structures including tendons, muscles, joints, vessels and internal organs for possible pathology or lesions. Obstetric sonography is commonly used during pregnancy and is widely...
is commonly performed, in which the size of the
kidneyThe kidneys are paired organs, which have the production of urine as their primary function. Kidneys are seen in many types of animals, including vertebrates and some invertebrates. They are part of the urinary system, but have several secondary functions concerned with homeostatic functions. ...
s are measured. Kidneys with CKD are usually smaller (< 9 cm) than normal kidneys with notable exceptions such as in
diabetic nephropathyDiabetic nephropathy , also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli. It is characterized by nephrotic syndrome and diffuse glomerulosclerosis...
and
polycystic kidney diseaseThe autosomal dominant form of Polycystic kidney disease called ADPKD is much more common but less severe than autosomal recessive polycystic kidney. In 85% of patients, ADPKD is caused by mutations in the gene PKD1 on chromosome 16 ; in 15% of patients mutations in PKD2 are causative...
. Another diagnostic clue that helps differentiate CKD and ARF 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). If these levels are unavailable (because the patient has been well and has had no blood tests) it is occasionally necessary to treat a patient briefly as having ARF until it has been established that the renal impairment is irreversible.
Additional tests may include
nuclear medicineNuclear medicine is a branch or specialty of medicine and medical imaging that uses radioactive isotopes and relies on the process of radioactive decay in the diagnosis and treatment of disease. In nuclear medicine procedures, radionuclides are combined with other chemical compounds or...
MAG3 scan to confirm blood flows and establish the differential function between the two kidneys.
DMSADimercaptosuccinic acid , is the organosulfur compound with the formula HO
2CCHCHCO
2H. This colourless solid contains two carboxylic acid and two thiol groups, the latter being responsible for its mildly unpleasant odour. It occurs in two diastereomers, meso and the chiral dl...
scans are also used in renal imaging; with both MAG3 and DMSA being used
chelatedChelation is the formation or presence of two or more separate bindings between apolydentate ligand and a single central atom.Usually these ligands are organic compounds, and are called chelants, chelators, chelating agents, or sequestering agents....
with the radioactive element
Technetium-99Technetium-99 is an isotope of technetium which decays with a half-life of 211,000 years, emitting soft beta rays but no gamma rays, and has a fission product yield of 6.0507% for thermal neutron fission of uranium-235...
.
In chronic renal failure treated with standard dialysis, numerous uremic toxins accumulate. These toxins show various cytotoxic activities in the serum, have different molecular weights and some of them are bound to other proteins, primarily to albumin. Such toxic protein bound substances are receiving the attention of scientists who are interested in improving the standard chronic dialysis procedures used today.
Stages
All individuals with a Glomerular filtration rate (GFR) <60 mL/min/1.73 m
2 for 3 months are classified as having chronic kidney disease, irrespective of the presence or absence of kidney damage. The rationale for including these individuals is that reduction in kidney function to this level or lower represents loss of half or more of the adult level of normal kidney function, which may be associated with a number of complications.
All individuals with kidney damage are classified as having chronic kidney disease, irrespective of the level of GFR. The rationale for including individuals with GFR 60 mL/min/1.73 m
2 is that GFR may be sustained at normal or increased levels despite substantial kidney damage and that patients with kidney damage are at increased risk of the two major outcomes of chronic kidney disease: loss of kidney function and development of cardiovascular disease.
The
loss of protein in the urineProteinuria means the presence of anexcess of serum proteins in the urine. The protein in the urine often causes the urine to become foamy, although foamy urine may also be caused by bilirubin in the urine , retrograde ejaculation, pneumaturia due to a fistula, or drugs such as pyridium.-...
is regarded as an independent marker for worsening of renal function and cardiovascular disease. Hence, British guidelines append the letter "P" to the stage of chronic kidney disease if there is significant protein loss.
Stage 1 CKD
Slightly diminished function; Kidney damage with normal or relatively high GFR (>90 mL/min/1.73 m
2). Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine test or imaging studies.
Stage 2 CKD
Mild reduction in GFR (60-89 mL/min/1.73 m
2) with kidney damage. Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine test or imaging studies.
Stage 3 CKD
Moderate reduction in GFR (30-59 mL/min/1.73 m
2). British guidelines distinguish between stage 3A (GFR 45-59) and stage 3B (GFR 30-44) for purposes of screening and referral.
Stage 4 CKD
Severe reduction in GFR (15-29 mL/min/1.73 m
2)
Preparation for renal replacement therapy
Stage 5 CKD
Established kidney failure (GFR <15 mL/min/1.73 m
2, or permanent renal replacement therapy (RRT)
Causes
The most common causes of CKD are
diabetic nephropathyDiabetic nephropathy , also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli. It is characterized by nephrotic syndrome and diffuse glomerulosclerosis...
,
hypertensionHypertension is a chronic medical condition in which the blood pressure is elevated. It is also referred to as high blood pressure or shortened to HT, HTN or HPN. The word "hypertension", by itself, normally refers to systemic, arterial hypertension.Hypertension can be classified as either...
, and
glomerulonephritisGlomerulonephritis, also known as glomerular nephritis, abbreviated GN, is a renal disease characterized by inflammation of the glomeruli, or small blood vessels in the kidneys. It may present with isolated hematuria and/or proteinuria ; or as a nephrotic syndrome, a nephritic syndrome, acute...
. Together, these cause approximately 75% of all adult cases. Certain geographic areas have a high incidence of HIV nephropathy.
Historically, kidney disease has been classified according to the part of the renal anatomy that is involved, as:
- Vascular
In zoology, "vascular" means "related to blood vessels", which are part of the Circulatory system. An organ or tissue that is vascularized is heavily endowed with blood vessels and thus richly supplied with blood....
, includes large vessel disease such as bilateral renal artery stenosisRenal artery stenosis is the narrowing of the renal artery, most often caused by atherosclerosis or fibromuscular dysplasia. This narrowing of the renal artery can impede blood flow to the target kidney...
and small vessel disease such as ischemic nephropathy, hemolytic-uremic syndromeIn medicine, hemolytic-uremic syndrome is a disease characterized by hemolytic anemia, acute renal failure and a low platelet count . It predominantly but not exclusively affects children. Most cases are preceded by an episode of diarrhea caused by E...
and vasculitisVasculitis refers to a heterogeneous group of disorders that are characterized by inflammatory destruction of blood vessels.Both arteries and veins are affected. Lymphangitis is sometimes considered a type of vasculitis....
- Glomerular, comprising a diverse group and subclassified into
- Primary Glomerular disease such as focal segmental glomerulosclerosis
Focal segmental glomerulosclerosis is a cause of nephrotic syndrome in children and adolescents, as well as an important cause of kidney failure in adults.It is also known as "focal glomerular sclerosis" or "focal nodular glomerulosclerosis"....
and IgA nephritis
- Secondary Glomerular disease such as diabetic nephropathy
Diabetic nephropathy , also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli. It is characterized by nephrotic syndrome and diffuse glomerulosclerosis...
and lupus nephritisLupus nephritis is an inflammation of the kidney caused by systemic lupus erythematosus , a disease of the immune system. Apart from the kidneys, SLE can also damage the skin, joints, nervous system and virtually any organ or system in the body....
- Tubulointerstitial including polycystic kidney disease
The autosomal dominant form of Polycystic kidney disease called ADPKD is much more common but less severe than autosomal recessive polycystic kidney. In 85% of patients, ADPKD is caused by mutations in the gene PKD1 on chromosome 16 ; in 15% of patients mutations in PKD2 are causative...
, drug and toxin-induced chronic tubulointerstitial nephritis and reflux nephropathyReflux nephropathy, RN is a term applied when small and scarred kidneys are associated with vesico-ureteric reflux . CPN being the commonest cause, there are other causes including analgesic nephropathy and obstructive injury. Scarring is essential in developing RN and occurs almost during the...
- Obstructive such as with bilateral kidney stone
Kidney stones or renal calculi are solid concretions or calculi formed in the kidneys from dissolved urinary minerals. Nephrolithiasis refers to the condition of having kidney stones...
s and diseases of the prostateThe prostate is a compound tubuloalveolar exocrine gland of the male mammalian reproductive system. Females do not have prostate glands...
Treatment
The goal of therapy is to slow down or halt the otherwise relentless progression of CKD to stage 5. Control of
blood pressureBlood pressure is the pressure exerted by circulating blood on the walls of blood vessels, and is one of the principal vital signs. During each heartbeat, BP varies between a maximum and a minimum pressure...
and treatment of the original disease, whenever feasible, are the broad principles of management. Generally, angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II receptor antagonists (ARBs) are used, as they have been found to slow the progression of CKD to stage 5. Although the use of ACE inhibitors and ARBs represents the current standard of care for patients with CKD, patients progressively lose kidney function while on these medications, as seen in the IDNT and RENAAL studies, which reported a decrease over time in estimated glomerular filtration rate (an accurate measure of CKD progression, as detailed in the K/DOQI guidelines) in patients treated by these conventional methods.
Currently, several compounds are in development for CKD. These include, but are not limited to,
bardoxolone methylBardoxolone methyl is a synthetic oleanane triterpenoid that is an orally-available first-in-class antioxidant inflammation modulator...
, olmesartan medoxomil,
sulodexideSulodexide is a highly purified mixture of glycosaminoglycans composed of low molecular weight heparin and dermatan sulfate .-Pharmacology:...
, and avosentan.
Replacement of
erythropoietinErythropoietin, or its alternative erythropoetin or EPO, is a glycoprotein hormone that controls erythropoiesis, or red blood cell production...
and vitamin D3, two hormones processed by the kidney, is usually necessary in patients with CKD, as is
calciumCalcium is the chemical element with the symbol Ca and atomic number 20. It has an atomic mass of 40.078 amu. Calcium is a soft grey alkaline earth metal, and is the fifth most abundant element by mass in the Earth's crust...
.
Phosphate bindersPhosphate binders are a group of medications used to reduce the absorption of phosphate and taken with meals and snacks. They are typically used in patients with chronic renal failure as they cannot get rid of the phosphate that gets into their blood Phosphate binders are a group of medications...
are used to control the serum
phosphateA phosphate, an inorganic chemical, is a salt of phosphoric acid. In organic chemistry, a phosphate, or organophosphate, is an ester of phosphoric acid. Organic phosphates are important in biochemistry and biogeochemistry or ecology. Inorganic phosphates are mined to obtain phosphorus for use in...
levels, which are usually elevated in chronic kidney disease.
When one reaches stage 5 CKD,
renal replacement therapyRenal replacement therapy is a term used to encompass life-supporting treatments for renal failure.It includes:*hemodialysis,*peritoneal dialysis,*hemofiltration and*renal transplantation....
is required, in the form of either
dialysisIn medicine, dialysis is primarily used to provide an artificial replacement for lost kidney function due to renal failure...
or a transplant.
In some cases, dietary modifications have been proven to slow and even reverse further progression. Generally this includes limiting a persons intake of protein.
Prognosis
The prognosis of patients with chronic kidney disease is guarded as
epidemiological dataEpidemiology is the study of factors affecting the health and illness of populations, and serves as the foundation and logic of interventions made in the interest of public health and preventive medicine...
has shown that all cause
mortalityDeath is the termination of the biological functions that define a living organism. It refers to both a particular event and to the condition that results thereby. The true nature of the latter has for millennia been a central concern of the world's religious traditions and of philosophical...
(the overall death rate) increases as kidney function decreases. The leading cause of death in patients with chronic kidney disease is cardiovascular disease, regardless of whether there is progression to stage 5.
While
renal replacement therapiesRenal replacement therapy is a term used to encompass life-supporting treatments for renal failure.It includes:*hemodialysis,*peritoneal dialysis,*hemofiltration and*renal transplantation....
can maintain patients indefinitely and prolong life, the
quality of lifeThe term quality of life is used to evaluate the general well-being of individuals and societies. The term is used in a wide range of contexts, including the fields of international development, healthcare, and political science. Quality of life should not be confused with the concept of...
is severely affected. Renal transplantation increases the survival of patients with stage 5 CKD significantly when compared to other therapeutic options; however, it is associated with an increased short-term mortality (due to complications of the surgery). Transplantation aside, high intensity
home hemodialysisHome hemodialysis , is the provision of hemodialysis in the home of people with stage 5 chronic kidney disease. In the US home hemodialysis was the most common method of renal replacement therapy in the early 1970s before the introduction of the Federal ESRD program under Medicare...
appears to be associated with improved survival and a greater
quality of lifeThe term quality of life is used to evaluate the general well-being of individuals and societies. The term is used in a wide range of contexts, including the fields of international development, healthcare, and political science. Quality of life should not be confused with the concept of...
, when compared to the conventional three times a week
hemodialysisIn medicine, hemodialysis is a method for removing waste products such as potassium and urea, as well as free water from the blood when the kidneys are in renal failure. Hemodialysis is one of three renal replacement therapies .Hemodialysis can be an outpatient or inpatient therapy...
and
peritoneal dialysisPeritoneal dialysis is a treatment for patients with severe chronic kidney failure. The process uses the patient's peritoneum in the abdomen as a membrane across which fluids and dissolved substances are exchanged from the blood...
.
Organizations
In the USA, the
National Kidney FoundationThe National Kidney Foundation, Inc. is a major voluntary health organization in the United States. Its mission is to prevent kidney and urinary tract diseases, improve the health and well-being of individuals and families affected by these diseases, and increase the availability of all organs...
is a national organization representing patients and professionals who treat kidney diseases. The
Renal Support NetworkThe Renal Support Network is an American nonprofit, kidney patient-focused, kidney patient-run organization that works to benefit individuals affected by chronic kidney disease...
(RSN) is a nonprofit, patient-focused, patient-run organization that provides non-medical services to those affected by CKD. The American Association of Kidney Patients (AAKP) is a non-profit, patient-centric group focused on improving the health and well-being of CKD and
dialysisIn medicine, dialysis is primarily used to provide an artificial replacement for lost kidney function due to renal failure...
patients. The
Renal Physicians AssociationThe Renal Physicians Association is an association representing nephrology professionals in the United States. RPA was founded in 1973 and headquartered in Rockville, MD. Their members are committed to improving the care of patients with chronic kidney disease and related disordersRPA educates...
(RPA) is an association representing
nephrologyNephrology is a branch of internal medicine and pediatrics dealing with the study of the function and diseases of the kidney.- Scope of the specialty :...
professionals.
In the United Kingdom, the National Kidney Federation represents patients, and the
Renal AssociationThe Renal Association is a British professional organisation of nephrologists . It was founded in 1950 by Arthur Arnold Osman after the example of the French Societé de Pathologie Renale. The current president is Professor Peter Mathieson...
represents renal physicians and works closely with the
National Service FrameworkNational Service Frameworks are policies set by the National Health Service in the United Kingdom to define standards of care for major medical issues such as cancer, coronary heart disease, mental health and diabetes...
for kidney disease.
The
International Society of NephrologyThe International Society of Nephrology is an international body representing specialists in nephrology . Its headquarters are located in Brussels, Belgium....
is an international body representing specialists in kidney diseases.
See also
- Acute renal failure
Acute renal failure , also known as acute kidney failure or acute kidney injury, is a rapid loss of renal function due to damage to the kidneys, resulting in retention of nitrogenous and non-nitrogenous waste products that are normally excreted by the kidney...
- Dialysis
In medicine, dialysis is primarily used to provide an artificial replacement for lost kidney function due to renal failure...
- Hepatorenal syndrome
Hepatorenal syndrome is a life-threatening medical condition that consists of rapid deterioration in kidney function in individuals with cirrhosis or fulminant liver failure...
- Renal failure
Renal failure or kidney failure is a situation in which the kidneys fail to function adequately. It is divided into acute and chronic forms; either form may be due to a large number of other medical problems....
- Artificial kidney
Artificial kidney is often a synonym for hemodialysis, but may also, more generally, refer to renal replacement therapies that are in use and/or in development...
External links