Chronic kidney disease

Chronic kidney disease (CKD) has a high mortality rate once it reaches the most severe stage. However, complications can be reduced and even prevented if it is diagnosed and treated earlier. Many people who develop CKD become symptomatic only when the disease is well established. By that point, the opportunity for some of the interventions aimed at minimising the impact of the disease has passed. Nurses working in general practice are well placed to recognise people at risk for CKD, diagnose them early and ensure that treatment is initiated and optimised to protect their renal and cardiovascular health.

The Quality and Outcomes Framework (QOF) was implemented in 2004 with the aim of ensuring that all patients had access to standardised, evidence-based care for their long-term condition. Points are awarded for meeting certain standards in each of theseconditions and the number of points earned is translated into money that is paid to the practice. Chronic kidney disease (CKD) is one of the long-term conditions with QOF points for registering and monitoring.

The effective management of long-term conditions such as chronic kidney disease (CKD) is probably the single greatest challenge faced by the NHS. The population is growing and people are living longer. Every week, the life expectancy for a newborn baby in the UK increases by more than 24 hours. While this is, in part, testament to the success of our health services, it also places steadily increasing demands upon them. As the population ages, the number of people living with long-term conditions is predicted to triple by 2050.

Chronic kidney disease (CKD) affects renal drug elimination and other important processes involved in drug disposition, including absorption, drug distribution and non-renal clearance. As a result, the reduced renal excretion of a drug or its metabolites can cause toxicity and the sensitivity to some drugs is increased even if elimination is unimpaired.

Chronic kidney disease (CKD) is characterised by irreversible renal scarring. Nephrologists draw the distinction between primarily glomerular scarring (glomerulosclerosis) and scarring centred on the kidney tubules (chronic tubulointerstitial nephritis). However, in clinical practice, glomerulosclerosis is by far the most common pattern in CKD and this article will focus on this type of renal injury.

Diagnosing chronic kidney disease (CKD) and monitoring kidney function are key steps in improving management. This article reviews the recommendations on making a diagnosis of CKD, including staging patients, and the tests available for monitoring kidney function, with explanations of how to test patients, what the findings mean, and how to act on the findings.

Chronic kidney disease (CKD) is a cardiovascular condition, with cardiovascular causes and consequences. The kidney complications are relatively uncommon. Until recently, many clinicians, let alone the public, were unaware of the high prevalence of the disease and its accompanying morbidity. The National Institute for Health and Clinical Excellence (NICE), through the National Collaborative Centre for Chronic Conditions, recently reviewed the available evidence and published a guideline to assist early identification and management of CKD.