Chronic kidney disease for nurses

Reading File

Finding Sources

Reading File

Finding Sources

Reading File

Finding Sources

Reading File

Searching PubMed

"chronic kidney disease" AND nursing

Searching Images

chronic kidney disease stages GFR diagram

Loading Image

Finding Sources

I now have comprehensive information from the medical library to deliver a thorough, nursing-oriented overview of CKD. Let me compile this into a well-structured response.

Chronic Kidney Disease (CKD) — Nursing Overview

Definition

CKD is defined as kidney damage or decreased kidney function persisting for ≥ 3 months, regardless of cause. It is a major public health burden, affecting approximately 1 in 7 adults in the United States. — Textbook of Family Medicine 9e

Staging (KDIGO Classification)

CKD is staged by estimated GFR (eGFR) and albuminuria category:

Stage	eGFR (mL/min/1.73 m²)	Description
G1	≥ 90	Kidney damage with normal/increased GFR
G2	60–89	Mildly decreased GFR
G3	30–59	Moderately decreased GFR
G4	15–29	Severely decreased GFR
G5	< 15	Kidney failure (ESKD)

Kidney damage is defined by structural abnormalities and/or persistent haematuria, proteinuria, or microalbuminuria for ≥ 3 months.

— Acute Kidney Injury: Prevention, Detection and Management

GFR Estimation Formulas

Nurses need to understand how GFR is calculated to interpret lab results and dose medications:

Cockcroft-Gault: CrCl (mL/min) = (140 − Age) × Weight / (72 × SCr) × 0.85 if female
MDRD equation: GFR = 1.86 × (SCr)^−1.154 × (Age)^−0.203 × 0.742 if female × 1.210 if Black

Key nursing point: A "normal" serum creatinine does not rule out CKD — eGFR can be substantially reduced even when creatinine appears normal, especially in elderly or low-muscle-mass patients.

— Textbook of Family Medicine 9e

Common Causes & Risk Factors

Diabetes mellitus (leading cause — ~40%)
Hypertension (second leading cause)
Glomerulonephritis
Polycystic kidney disease
Recurrent UTIs / pyelonephritis
Nephrotoxic drugs (NSAIDs, aminoglycosides, contrast agents)
Cardiovascular disease (shared risk factors)
Tobacco use

Assessment & Monitoring (Nursing Priorities)

Laboratory Values to Monitor

Lab	Normal	CKD Concern
eGFR	≥ 60	< 60 for ≥ 3 months
Serum creatinine	0.6–1.2 mg/dL	Rising trend
BUN (Blood Urea Nitrogen)	7–20 mg/dL	Elevated → uremia
Potassium	3.5–5.0 mEq/L	Hyperkalemia risk
Phosphate	2.5–4.5 mg/dL	Elevated in CKD
Calcium	8.5–10.5 mg/dL	Low (hypocalcemia)
Hemoglobin	≥ 12 g/dL	Anemia of CKD
Albumin	3.5–5.0 g/dL	Low → malnutrition
HbA1c	< 7% (diabetics)	Poor control accelerates CKD
Urine albumin-to-creatinine ratio (UACR)	< 30 mg/g	≥ 30 = albuminuria

Diagnostic Workup

Complete urinalysis (protein, casts, RBCs)
Renal ultrasound (size, echogenicity, obstruction)
Serum electrolytes, creatinine, albumin
UACR on spot urine sample

Complications: The "AEIOU" Mnemonic

1. Anemia

Due to decreased erythropoietin (EPO) production
Treated with erythropoiesis-stimulating agents (ESAs, e.g., epoetin alfa) and IV iron
Target Hgb: 10–12 g/dL (avoid > 13 g/dL due to CV risk)

2. Electrolyte & Acid-Base Disturbances

Hyperkalemia — life-threatening; restrict dietary potassium; use kayexalate or patiromer
Metabolic acidosis — treat with oral sodium bicarbonate if bicarbonate < 22 mEq/L
Hyperphosphatemia — use phosphate binders (calcium carbonate, sevelamer) with meals

3. Immune & Infection Risk

Impaired leukocyte function → increased infection susceptibility
Ensure vaccinations: pneumococcal, influenza, hepatitis B (give early — response declines with lower eGFR)

4. Osteodystrophy (CKD-MBD)

Elevated phosphate → suppressed calcitriol (active Vit D) → secondary hyperparathyroidism → bone disease
PTH monitoring; activated Vit D supplementation (calcitriol)

5. Uremia (advanced CKD/Stage 5)

Accumulation of urea and uremic toxins
Symptoms: nausea, vomiting, confusion, pruritus, pericarditis, asterixis ("uremic flap")
Indicates need for dialysis initiation

Additional Complications

Hypertension (contributes to and results from CKD — vicious cycle)
Cardiovascular disease (leading cause of death in CKD)
Fluid overload / edema — monitor weight daily, assess for pulmonary edema
Malnutrition — protein-energy wasting common in advanced CKD

Medical Management (Key Medications)

Drug Class	Example	Purpose
ACE inhibitors / ARBs	Lisinopril, losartan	Slow CKD progression (especially with diabetes/proteinuria)
SGLT-2 inhibitors	Empagliflozin, dapagliflozin	Nephroprotection in diabetic CKD
Loop diuretics	Furosemide	Fluid/edema management
Phosphate binders	Sevelamer, calcium carbonate	Hyperphosphatemia
ESAs	Epoetin alfa	Anemia of CKD
IV Iron	Ferric gluconate	Iron deficiency + anemia
Sodium bicarbonate	Oral	Metabolic acidosis
Antihypertensives	Amlodipine, metoprolol	BP < 130/80 mmHg target

Nursing alert: Many medications require dose adjustment or are contraindicated in CKD (e.g., metformin, NSAIDs, certain antibiotics). Always check eGFR before administering renally-cleared drugs.

Dietary & Fluid Management

Restriction	Rationale
Protein restriction (~0.6–0.8 g/kg/day in non-dialysis)	Reduces urea load and slows progression
Potassium restriction	Prevent hyperkalemia
Phosphorus restriction	Prevent renal osteodystrophy
Sodium restriction (< 2 g/day)	BP control and fluid management
Fluid restriction	Individualized — important in advanced CKD and dialysis patients

Diet is an underused strategy for preventing CKD progression to ESKD. — Brenner and Rector's The Kidney

Renal Replacement Therapy (RRT) — Preparing Patients

Patients with Stage 4 CKD (eGFR < 30) should be educated and prepared for RRT options:

1. Hemodialysis (HD)

Blood filtered via dialyzer 3× per week (~4 hrs/session)
Requires arteriovenous fistula (AVF), graft, or central venous catheter access
Nursing: monitor pre/post vitals, weight, vascular access site, hypotension, cramps

2. Peritoneal Dialysis (PD)

Peritoneum acts as dialysis membrane
Patient performs exchanges at home (CAPD or APD)
Nursing: teach sterile technique for exchanges, exit-site care, signs of peritonitis

3. Kidney Transplantation

Best long-term outcomes; requires immunosuppression
Pre-transplant workup begins early at Stage 4–5

4. Conservative Management

For patients who decline dialysis; focused on symptom management and quality of life

— Evaluation and Management of Chronic Kidney Disease

Nursing Care Priorities Summary

🔍 Assessment

Daily weight (fluid status)
BP and HR (target < 130/80 mmHg)
Urine output (oliguria/anuria = concern)
Edema: peripheral, pulmonary
Skin: pallor (anemia), pruritus (uremia), bruising
Neurological: confusion, asterixis (uremia)
Pain, fatigue, dyspnea

🩺 Nursing Diagnoses

Excess fluid volume r/t decreased urine output
Risk for electrolyte imbalance (hyperkalemia, acidosis)
Imbalanced nutrition: less than body requirements
Activity intolerance r/t anemia
Deficient knowledge r/t disease management and diet
Risk for infection (access site, decreased immunity)

📋 Patient Education Priorities

Diet: low potassium, phosphorus, sodium, and protein
Medications: importance of adherence; avoid NSAIDs and nephrotoxins
Fluid management: daily weights, fluid targets
Dialysis access care (fistula/graft/PD catheter)
Signs of complications: worsening edema, dyspnea, palpitations (hyperkalemia)
Vaccinations (hep B, flu, pneumococcal)
BP monitoring at home
Referrals: dietitian, social work, nephrology

📊 Referral Triggers

eGFR < 30 → refer to nephrologist
eGFR < 20 → begin RRT planning and vascular access placement
eGFR < 15 → initiate dialysis or conservative care planning

Sources

Textbook of Family Medicine, 9e (Brenner & Rector approach)
Brenner and Rector's The Kidney, 2-Volume Set
Acute Kidney Injury: Prevention, Detection and Management
Evaluation and Management of Chronic Kidney Disease

This is a shared conversation. Sign in to Orris to start your own chat.