Chronic Kidney Disease Questions & Answers

Updated: Oct 26, 2020
  • Author: Pradeep Arora, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Questions & Answers

Overview

What is chronic kidney disease (CKD)?

How does the National Kidney Foundation (NKF) define chronic kidney disease (CKD)?

What are the stages of chronic kidney disease (CKD)?

Which markers of kidney damage can establish diagnosis of stage 1 and stage 2 chronic kidney disease (CKD)?

How are glomerular filtration rate (GFR) and albuminuria levels used in the assessment of chronic kidney disease (CKD)?

When do symptoms of chronic kidney disease (CKD) develop?

What are the signs of metabolic acidosis in stage 5 chronic kidney disease (CKD)?

Which disturbances in water or electrolyte balance are clinically evident in stage 5 chronic kidney disease (CKD)?

Which symptoms are associated with anemia in chronic kidney disease (CKD)?

Which extrarenal symptoms may be observed in end-stage renal disease (ESRD)?

What are the American College of Physicians guidelines on screening for chronic kidney disease (CKD)?

Which lab studies are used in the diagnosis of chronic kidney disease (CKD)?

Which tests can be used to detect of renal bone disease?

Which secondary tests may be ordered as part of the evaluation of chronic kidney disease (CKD)?

Which imaging studies are used in the diagnosis of chronic kidney disease (CKD)?

When is biopsy indicated for diagnosis of chronic kidney disease (CKD)?

What is the focus of the medical care of patients with chronic kidney disease (CKD)?

How is chronic kidney disease (CKD) managed?

What are the indications for renal replacement therapy in chronic kidney disease (CKD)?

What is chronic kidney disease–mineral and bone disorder (CKD-MBD) and what causes it?

How does the kidney maintain glomerular filtration rate (GFR) in the setting of renal injury?

Which plasma values are affected by a decreased glomerular filtration rate (GFR)?

What is hypothesized to be the negative effect of hyperfiltration and hypertrophy of nephrons in the setting of renal dysfunction?

Which factors, other than the underlying disease process and glomerular hypertension, may cause progressive renal injury?

What is the role of acute kidney injury (AKI) in the development of chronic kidney disease (CKD) in patients with diabetes mellitus?

Which two factors have been suggested as antecedent pathways for chronic kidney disease (CKD)?

When does the glomerular filtration rate (GFR) in children reach adult levels?

Which patient attributes are factors in interpreting creatinine measurements in chronic kidney disease (CKD)?

What are the causes of chronic kidney disease (CKD) in children?

How does aging affect renal mass and the number of glomeruli in the kidney?

Which anatomic and functional changes contribute to a decrease in renal blood flow over time?

Does the vasoconstrictor response to intrarenal angiotensin vary at different ages?

What is the role of age in the decline of the glomerular filtration rate (GFR)?

Which genetic mutations and syndromes are associated with chronic kidney disease (CKD)?

What is the role of the APOL1 gene in the risk for development or progression of chronic kidney disease (CKD)?

What is the role of fibroblast growth factor 23 (FGF-23) in the risk for development or progression of chronic kidney disease (CKD)?

Which genetic variations have been associated with the development of albuminuria in the setting of chronic kidney disease (CKD)?

What is the role of the renin-angiotensin system (RAS) in predisposing a person to chronic kidney disease (CKD)?

What factors may contribute to hyperkalemia and when does it typically occur in cases of chronic kidney disease (CKD)?

What causes hypokalemia in cases of chronic kidney disease (CKD)?

What causes metabolic acidosis in cases of chronic kidney disease (CKD)?

What issues may arise from the negative effects of metabolic acidosis in cases of chronic kidney disease (CKD)?

How does chronic kidney disease (CKD) affect the handling of salt and water in the kidney and what are the effects?

How do tubulointerstitial renal diseases develop in cases of chronic kidney disease (CKD)?

What are the causes of anemia and what is the prevalence in cases of chronic kidney disease (CKD)?

What is the role of chronic kidney disease (CKD) in the development of bone disease?

What are the effects of bone disease in children with chronic kidney disease (CKD)?

Which factors are involved in the development of secondary hyperparathyroidism in cases of chronic kidney disease (CKD)?

What are the causes and effects of hyperphosphatemia in chronic kidney disease (CKD)?

What causes hypocalcemia in chronic kidney disease (CKD)?

What conditions trigger elevated parathyroid hormone (PTH) levels in chronic kidney disease (CKD)?

What is osteitis fibrosa and how does it relate to chronic kidney disease (CKD)?

What causes adynamic bone disease and what is its prevalence in the US?

What is associated with low-turnover osteomalacia in chronic kidney disease (CKD)?

What is dialysis-related amyloidosis bone disease?

What are causes of chronic kidney disease (CKD)?

Which vascular diseases can cause chronic kidney disease (CKD)?

Which conditions can be classified as a primary glomerular disease?

What are the secondary causes of glomerular disease?

What are the causes of tubulointerstitial disease?

What are the causes of urinary tract obstruction?

What is the prevalence of chronic kidney disease (CKD) in the US?

What are the incidence and prevalence of chronic kidney disease (CKD) among different age groups in the US?

What is the prevalence of chronic kidney disease (CKD) by stage in the US?

How has the incidence of end-stage renal disease (ESRD) in the US changed over time?

What efforts have been made to reduce the incidence and effects of renal failure in the US?

What is the global prevalence of chronic kidney disease (CKD)?

How does chronic kidney disease (CKD) affect black patients differently from white patients?

What differences exist in the frequency of specific causes of chronic kidney disease (CKD) among different races?

Is end-stage renal disease (ESRD) more common in males or females?

What factors contribute to CKD in children occurring more frequently in boys than in girls?

What factors affect the rate of progression of chronic kidney disease (CKD)?

Which routine lab results can be used to predict the progression of chronic kidney disease (CKD) to kidney failure?

What are the hospitalization rates for patients with chronic kidney disease (CKD)?

How does hemodialysis affect the prognosis for chronic kidney disease (CKD)?

What is the difference in hospitalization rates between patients with chronic kidney disease (CKD) treated with dialysis and those who receive a kidney transplant?

What is the difference in vascular access complications rates between a 3-day dialysis regimen and a 6-day dialysis regimen in patients with chronic kidney disease (CKD)?

What are the mortality rates associated with chronic kidney disease (CKD)?

What is the most common cause of death related to end-stage renal disease (ESRD)?

How does the morbidity and mortality of dialysis patients in the US compare to that in other countries?

Which condition is associated with bicarbonate and C-reactive protein levels in patients treated with dialysis?

How are 25-hydroxyvitamin D levels correlated with mortality in nondialysis chronic kidney disease (CKD)?

How does morbidity and mortality in children with chronic kidney disease (CKD) compare with that in adults?

How does chronic kidney disease (CKD) affect reproductive organs and fertility?

How do 25(OH)D levels correlate with mortality risk in chronic kidney disease (CKD)?

What educational information should be provided to patients with chronic kidney disease (CKD)?

What educational information should be provided to women of childbearing age with end-stage renal disease (ESRD)?

Presentation

Which clinically evident symptoms are associated with the different stages of chronic kidney disease (CKD)?

How does uremia manifest in chronic kidney disease (CKD) stage 5?

How does anemia manifest in chronic kidney disease (CKD)?

What are the manifestations of uremia in end-stage renal disease (ESRD)?

What findings may be noted during the physical exam of a patient with chronic kidney disease (CKD)?

Which depression screening tools are effective in the evaluation of adult patients with chronic kidney disease (CKD) and when should they be used?

DDX

Which studies should be considered in the initial workup of suspected chronic kidney disease (CKD)?

Which conditions are included in the differential diagnoses of chronic kidney disease (CKD)?

What are the differential diagnoses for Chronic Kidney Disease?

Workup

Which lab tests are typically included in the workup of chronic kidney disease (CKD)?

Which lab findings are associated with chronic kidney disease (CKD)?

Why should a lipid profile be included in the workup of chronic kidney disease (CKD)?

Which lab tests may be ordered to evaluate for renal bone disease in chronic kidney disease (CKD)?

What is the role of cystatin-C in determining the level of kidney function in chronic kidney disease (CKD)?

Which tests may be used to screen for comorbidities in the evaluation of chronic kidney disease (CKD)?

What are the evidence-based recommendations regarding screening, monitoring, and treatment of adults with stage 1-3 chronic kidney disease (CKD)?

What is the prevalence of unrecognized chronic kidney disease (CKD) among individuals with one or more risk factors for CKD?

Which screening test may be used to exclude chronic kidney disease (CKD) in adults who do not have risk factors for CKD?

Which test can be used to determine total protein and creatinine clearance (CrCl) in the evaluation for chronic kidney disease (CKD), and when should it be administered?

Which tests are used to screen patients at elevated risk for chronic kidney disease (CKD)?

Which tests are recommended for monitoring proteinuria in adults with chronic kidney disease (CKD)?

Which complications of chronic kidney disease (CKD) are associated with a positive dipstick result?

What is the Cockcroft-Gault formula for estimating creatinine clearance (CrCl) and how is it used in patients with chronic kidney disease (CKD)?

What equations calculate glomerular filtration rate (GFR) in patients with chronic kidney disease (CKD), and how accurate are they?

What formula is used to calculate glomerular filtration rate (GFR) in children with chronic kidney disease (CKD)?

What is the role of age in estimating glomerular filtration rate (GFR) in chronic kidney disease (CKD), and how is GFR calculated in elderly patients?

What is the role of renal ultrasonography in the workup of chronic kidney disease (CKD)?

What is the role of radiography in the workup of chronic kidney disease (CKD)?

What is the role of CT scanning in the workup for chronic kidney disease (CKD)?

What are the roles of MRI and MRA in the workup for chronic kidney disease (CKD)?

What is the role of renal radionuclide scanning in the workup for chronic kidney disease (CKD)?

When is percutaneous renal biopsy indicated in the workup for chronic kidney disease (CKD)?

What is the most common complication of renal biopsy, and how is that risk mitigated?

What is the role of renal histology in the workup of in chronic kidney disease (CKD)?

Treatment

What is the focus of medical care in chronic kidney disease (CKD)?

According to the Canadian Society of Nephrology guidelines, what criteria are used to determine when dialysis should be initiated in chronic kidney disease (CKD)?

What steps can be taken to delay or halt the progression of chronic kidney disease (CKD)?

What is the benefit of treatment with ACE inhibitors or ARBs in advanced chronic kidney disease (CKD) and stable hypertension?

What is the role of SGLT2 inhibitors in the treatment of chronic kidney disease (CKD)?

What is the role of finerenone in the treatment of chronic kidney disease (CKD)?

What is the role of blood pressure control in chronic kidney disease (CKD) and what is the suggested target blood pressure?

Is systolic blood pressure control or diastolic blood pressure control more important in chronic kidney disease (CKD)?

What is the role of systolic blood pressure in the progression of chronic kidney disease (CKD) to end-stage renal disease (ESRD)?

Which serum levels should be monitored in chronic kidney disease (CKD) treated with ACE inhibitor and ARB antihypertensive medications?

When are antihypertensive medications indicated for the treatment of proteinuria in diabetic and nondiabetic chronic kidney disease (CKD)?

What is the effect of dietary protein restriction on glomerular filtration rate (GFR) in chronic kidney disease (CKD)?

What is the role of paricalcitol (Zemplar) in chronic kidney disease (CKD)?

What is the role of daily cholecalciferol (Vitamin D) in chronic kidney disease (CKD)?

What risk is associated with NSAIDs in chronic kidney disease (CKD)?

What is the effect of smoking on kidney failure?

What is the role of thyroid hormone replacement therapy (THRT) in the treatment of chronic kidney disease (CKD)?

What are the pathologic manifestations of chronic kidney disease (CKD) and how are they treated?

What is the target hemoglobin level in patients undergoing erythropoietin treatment in the setting of chronic kidney disease (CKD)?

What are the benefits of controlled hemoglobin A1c levels in chronic kidney disease (CKD)?

What is the treatment for abnormal mineral homeostasis in chronic kidney disease (CKD)?

What are the target phosphate levels in chronic kidney disease (CKD)?

What strategies may be used to achieve recommended phosphorus levels in hyperphosphatemia and chronic kidney disease (CKD)?

Which factors should be considered in the selection of a phosphate-binding agent for the treatment of hyperphosphatemia in chronic kidney disease (CKD)?

What are the effects of phosphate-binding agents in chronic kidney disease (CKD)?

What are the benefits and risks of correcting metabolic acidosis in chronic kidney disease (CKD)?

What is the effect of bicarbonate supplementation on renal function in chronic kidney disease (CKD)?

How are the cardiovascular risks associated with chronic kidney disease (CKD) managed?

What are the indications for renal replacement therapy in chronic kidney disease (CKD)?

What factors should be considered when planning for long-term renal replacement therapy in chronic kidney disease (CKD)?

When is protein restriction recommended as a strategy to manage glomerular filtration rate (GFR) in chronic kidney disease (CKD)?

What is the role of a low-protein diet in the treatment of chronic kidney disease (CKD)?

What is the effect of protein restriction on nutritional status in chronic kidney disease (CKD)?

What is the role of salt restriction in the treatment of diabetic chronic kidney disease (CKD)?

What is the maximum recommended daily intake of sodium for the general population?

Is salt restriction necessary in concomitant chronic kidney disease (CKD) and tubulointerstitial disease?

What are the benefits of dietary sodium reduction in nondiabetic chronic kidney disease (CKD)?

Which dietary restrictions, other than protein, may be indicated for chronic kidney disease (CKD)?

What are the benefits of increasing dietary fruits and vegetables on kidney function?

Which assessments may be used to monitor nutritional parameters in adult patients with chronic kidney disease (CKD) who are on maintenance dialysis?

Which activity modifications are used in the treatment of chronic kidney disease (CKD)?

What consultations are indicated for the management of chronic kidney disease (CKD)?

What is the association between obstructive sleep apnea (OSA) and chronic kidney disease (CKD)?

Guidelines

Which organizations have issued guidelines on the management of chronic kidney disease (CKD)?

Medications

What is the role of the glomerular filtration rate (GFR) in determining medication dosages in chronic kidney disease (CKD)?

Why is it important to monitor medication dosages and levels in patients undergoing dialysis as well as hospitalized patients with chronic kidney disease (CKD)?

What medication treatments and dietary adjustments can be used to treat the pathologic manifestations of chronic kidney disease (CKD)?

Which medications in the drug class Calcimimetics are used in the treatment of Chronic Kidney Disease?

Which medications in the drug class Iron Products are used in the treatment of Chronic Kidney Disease?

Which medications in the drug class Hematopoietic Growth Factors are used in the treatment of Chronic Kidney Disease?

Which medications in the drug class PO4 Scavengers are used in the treatment of Chronic Kidney Disease?

Which medications in the drug class Vitamin D Analogues are used in the treatment of Chronic Kidney Disease?

Which medications in the drug class Calcium Salts are used in the treatment of Chronic Kidney Disease?