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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. List the risk factors for development and progression of chronic kidney disease (CKD).

  2. Explain the mechanisms associated with progression of CKD.

  3. Outline the desired outcomes for treatment of CKD.

  4. Develop a therapeutic approach to slow progression of CKD including lifestyle modifications and pharmacologic therapies.

  5. Identify specific consequences associated with CKD.

  6. Design an appropriate therapeutic approach for specific consequences associated with CKD.

  7. Recommend an appropriate monitoring plan to assess the effectiveness of pharmacotherapy for CKD and specific consequences.

  8. Educate patients with CKD about the disease state, the specific consequences, lifestyle modifications, and pharmacologic therapies used for treatment of CKD.

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KEY CONCEPTS

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  • Image not available. Chronic kidney disease (CKD) is defined by a staging system based on glomerular filtration rate (GFR) level, which also accounts for evidence of kidney damage in the absence of changes in GFR, as in stage 1 CKD.

  • Image not available. CKD is a progressive disease that eventually leads to kidney failure (end-stage kidney disease [ESKD]).

  • Image not available.Early detection and treatment of CKD are fundamental factors in minimizing morbidity and mortality associated with CKD.

  • Image not available.Declining kidney function disrupts the homeostasis of the systems regulated by the kidney, leading to fluid and electrolyte imbalances, anemia, and metabolic bone disease.

  • Image not available.Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor blockers decrease protein excretion and are the drugs of choice for hypertension in patients with CKD.

  • Image not available.The most common complication of CKD is anemia, which is caused by a decline in erythropoietin production by the kidneys and can lead to cardiovascular disease (CVD).

  • Image not available.Bone and mineral metabolism disorders stem from disruptions in calcium, phosphorus, and vitamin D homeostasis through the interaction with the parathyroid hormone.

  • Image not available.The management of secondary hyperparathyroidism (sHPT) involves correction of serum calcium and phosp-horus levels, and decreasing parathyroid hormone secretion.

  • Image not available.Patient education and planning for dialysis should begin at stage 4 CKD, before ESKD is reached, to allow for time to establish appropriate access for dialysis.

  • Image not available.Dialysis involves the removal of metabolic waste products and excess fluids and electrolytes by diffusion and ultrafiltration from the bloodstream across a semipermeable membrane into an external dialysate solution.

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The kidney is made up of approximately 2 million nephrons that are responsible for filtering, reabsorbing, and excreting solutes and water. As the number of functioning nephrons declines, the primary functions of the kidney that are affected include:

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  • Production and secretion of erythropoietin

  • Activation of vitamin D

  • Regulation of fluid and electrolyte balance

  • Regulation of acid–base balance

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Chronic kidney disease (CKD), also known as chronic kidney insufficiency, progressive kidney disease, or nephropathy, is defined as the presence of kidney damage or decreased glomerular filtration rate (GFR) for 3 months or more.1 Generally, CKD is a progressive decline in kidney function (a decline in the number of functioning nephrons) that occurs over a period of several months to years. A decline ...

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