Alicic RZ, Rooney MT, Tuttle KR. Diabetic kidney disease: challenges, progress, and possibilities. Clin J Am Soc Nephrol. 2017; 12:(12)2032-2045

Alston H. Conservative care for end-stage kidney disease: joint medical conference with the Renal Association, British Geriatrics Society and Association for Palliative Medicine. Clin Med (Northfield Ill). 2013; 13:(4)383-386

Ashley C, Dunleavy A. The renal drug handbook, 5th edn. Abingdon: CRC Press; 2018

Baldwin JJ, Edwards JE. Uremic pericarditis as a cause of cardiac tamponade. Circulation. 1976; 53:(5)896-901

Transplant first: timely listing for kidney transplantation. 2013. (accessed 31 January 2022)

Bataille S, Brunet P, Decourt A Pericarditis in uremic patients: serum albumin and size of pericardial effusion predict drainage necessity. J Nephrol. 2015; 28:(1)97-104

Danovitch G. Handbook of kidney transplantation, 5th edn. Philadelphia (PA): Lippincott Williams & Wilkins; 2010

Dobre M, Meyer T, Hostetter T. The uraemic syndrome, 2nd edn. In: Kimmel P, Rosenberg M (eds). Cambridge (MA): Academic Press/Elsevier; 2019

Drey N, Roderick P, Mullee M, Rogerson M. A population-based study of the incidence and outcomes of diagnosed chronic kidney disease. Am J Kidney Dis. 2003; 42:(4)677-684

Dunsmore V. Renal transplantation, 5th edn. In: Thomas N (ed). Chichester: John Wiley; 2019

Eng M, Jones CM, Cannon RM, Marvin MR. Hand-assisted laparoscopic nephrectomy for polycystic kidney disease. JSLS. 2013; 17:(2)279-284

Fu R, Sekercioglu N, Berta W, Coyte PC. Cost-effectiveness of deceased-donor renal transplant versus dialysis to treat end-stage renal disease: a systematic review. Transplant Direct. 2020; 6:(2)e522-e522

Garfinkle MA, Barton J. Pedal edema and jugular venous pressure for volume overload in peritoneal dialysis patients. Can J Kidney Health Dis. 2016; 3:(1)

CKD summary overview. 2021. (accessed 26 January 2022)

, 14th edn. In: Innes JA, Dover AR, Fairhurst K (eds). Edinburgh: Elsevier; 2018

Jarl J, Desatnik P, Peetz Hansson U, Prütz KG, Gerdtham UG. Do kidney transplantations save money? A study using a before–after design and multiple register-based data from Sweden. Clin Kidney J. 2018; 11:(2)283-288

Jha V, Garcia-Garcia G, Iseki K Chronic kidney disease: global dimension and perspectives. Lancet. 2013; 382:(9888)260-272

British national formulary 80.London: BMJ Publishing and the Royal Pharmaceutical Society; 2020

Kashtan CE. Alport syndrome: achieving early diagnosis and treatment. Am J Kidney Dis. 2021; 77:(2)272-279

Chronic kidney disease in England: the human and financial cost. 2012. (accessed 26 January 2022)

Kidney Disease Improving Global Outcomes. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. 2013. (accessed 26 January 2022)

Kshirsagar AV, Bang H, Bomback AS A simple algorithm to predict incident kidney disease. Arch Intern Med. 2008; 168:(22)2466-2473

Ku E, Lee BJ, Wei J, Weir MR. Hypertension in CKD: core curriculum 2019. Am J Kidney Dis. 2019; 74:(1)120-131

Lambert MP. Platelets in liver and renal disease. Hematology. 2016; 2016:(1)251-255

Diabetic kidney disease. 2021. (accessed 26 January 2022)

Lombardo R, Tubaro A, Burkhard F. Nocturia: the complex role of the heart, kidneys, and bladder. Eur Urol Focus. 2020; 6:(3)534-536

Luis-Lima S, Porrini E. An overview of errors and flaws of estimated GFR versus true GFR in patients with diabetes mellitus. Nephron. 2017; 136:(4)287-291

Madeux B, Pons B, Elkoun K, Thiery G. Uraemic frost: a clinical manifestation of severe uraemia. Postgrad Med J. 2016; 92:(1090)491-491

Marcus G, Vessey J, Jordan MV Relationship between accurate auscultation of a clinically useful third heart sound and level of experience. Arch Intern Med. 2006; 166:(6)617-622

Mathur R, Dreyer G, Yaqoob MM, Hull SA. Ethnic differences in the progression of chronic kidney disease and risk of death in a UK diabetic population: an observational cohort study. BMJ Open. 2018; 8:(3)e020145-e020145

Matsushita K, van der Velde M, Astor BC Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010; 375:(9731)2073-2081

ANCA associated vasculitis and the kidney. 2018. (accessed 26 January 2022)

McGee S. Evidence-based physical diagnosis, 4th edn. London: Elsevier; 2018

Morris P, Knechtle S, Marson L. Kidney transplantation: principles and practice, 8th edn. London: Elsevier; 2020

Murray AM, Tupper DE, Knopman DS Cognitive impairment in hemodialysis patients is common. Neurology. 2006; 67:(2)216-223

NHS Digital. Health survey for England 2016: kidney and liver disease. 2017. (accessed 26 January 2022)

National Institute for Health and Care Excellence. Renal replacement therapy and conservative management. NICE guideline NG107. 2018. (accessed 26 January 2022)

National Institute for Health and Care Excellence. Hypertension in adults: diagnosis and management. NICE guideline NG136. 2019. (accessed 26 January 2022)

National Institute for Health and Care Excellence. Chronic kidney disease: assessment and management. NICE guideline NG203. 2021a. (accessed 26 January 2022)

National Institute for Health and Care Excellence. Chronic kidney disease: ACE-inihibitors and AIIRAs. Clinical knowledge summary. 2021b. (accessed 26 January 2022)

Neild GH, Alston H, Burns A. Half and half nails. NDT Plus. 2011; 4:(5)

Noble H, Carswell C, Walsh I. Nondialytic options and the role of palliative care, 5th edn. In: Thomas N (ed). Hoboken (NJ): Wiley-Blackwell; 2019

Uremic encephalopathy. 2021. (accessed 26 January 2022)

Rácz O, Lepej J, Fodor B, Lepejová K, Jarčuška P, Kováčová A Pitfalls in the measurements and assessment of glomerular filtration rate and how to escape them. EJIFCC. 2012; 23:(2)33-40

Ramani S, Weber BN. Detecting the gallop: the third heart sound and its significance. Med J Aust. 2017; 206:(5)198-199

Schrauben S, Berns J. Haematologic complications of chronic kidney disease: anaemia and platelet disorders, 2nd edn. In: Kimmel P, Rosenberg M (eds). Cambridge (MA): Academic Press/Elsevier; 2019

Stern AB, Klemmer PJ. High-output heart failure secondary to arteriovenous fistula. Hemodial Int. 2011; 15:(1)104-107

Tattersall J, Dekker F, Heimbürger O When to start dialysis: updated guidance following publication of the Initiating Dialysis Early and Late (IDEAL) study. Nephrol Dial Transplant. 2011; 26:(7)2082-6

Think Kidneys. ‘Sick day’ guidance in patients at risk of acute kidney injury. 2020. (accessed 26 January 2022)

Thomas N. Renal nursing: care and management of people with kidney disease, 5th edn. Hoboken (NJ): Wiley-Blackwell; 2019

Treharne C, Liu FX, Arici M, Crowe L, Farooqui U. Peritoneal dialysis and in-centre haemodialysis: a cost-utility analysis from a UK payer perspective. Appl Health Econ Health Policy. 2014; 12:(4)409-20

Trevisani F, Di Marco F, Capitanio U Renal function assessment gap in clinical practice: an awkward truth. Kidney Blood Press Res. 2020; 45:(2)166-179

Turner AN, Savill J, Stewart LH, Cumming A. Kidney and genitourinary disease, 19th edn. In: Haslett C, Chilvers E, Boon N, Colledge N. Edinburgh: Churchill Livingstone; 2002

Udayaraj U, Pruthi R, Casula A, Roderick P. UK Renal Registry 16th annual report: chapter 6 demographics and outcomes of patients from different ethnic groups on renal replacement therapy in the UK. Nephron Clin Pract. 2013; 125:(1-4)111-125

UK Kidney Association. About eGFR. 2020. (accessed 26 January 2022)

Summary of annual report: analyses of adult data to the end of 2018.London: Renal Association; 2019

UK Renal Registry. UK Renal Registry 22nd annual report—data to 31/12/2018. 2020.

Chronic renal failure. 2020. (accessed 26 January 2022)

Vanholder R, Van Laecke S, Glorieux G, Verbeke F, Castillo-Rodriguez E, Ortiz A. Deleting death and dialysis: conservative care of cardio-vascular risk and kidney function loss in chronic kidney disease (CKD). Toxins (Basel). 2018; 10:(6)

Verberne W, Geers T, Jellema W, Vincent J, van Delden H, Bos W. SP639. Quality of life in older patients with end-stage renal disease: Comparison of comprehensive conservative care and dialysis. Nephrology, Dialysis, Transplantation. 2017; 32:iii351-iii352

Uraemic pruritus. 2010. (accessed 26 January 2022)

Prescribing. 2021. (accessed 26 January 2022)

Chronic kidney disease and renal replacement therapy: an overview for the advanced clinical practitioner

10 February 2022
27 min read
Volume 31 · Issue 3


Chronic kidney disease (CKD), also known as chronic renal failure (CRF), is a common, globally significant condition, with associated significant mortality and morbidity. Due to the disease prevalence, advanced clinical practitioners (ACPs) in a variety of primary and secondary care settings will encounter patients with this diagnosis who will require care and treatment. This article examines definitions of CKD, describes a clinical approach to a patient with CKD, including key history and examination findings, and provides a brief overview of renal replacement strategies for the patient with end-stage renal failure. ACPs require a thorough understanding of this condition and the key elements of treatment and care in this population.

Chronic kidney disease (CKD) is a common, globally significant condition, with associated significant mortality and morbidity. Globally, CKD has been ranked as the 18th most common cause of death, but with a disproportionately high loss of years of life associated with the condition (Jha et al, 2013). CKD is commonly classified according to glomerular filtration rate (GFR), with lower GFRs corresponding to worse disease, and a GFR of 5 representing ‘end-stage’ kidney disease (ESKD). For many advanced clinical practitioners (ACPs), CKD, dialysis and transplantation can be areas of clinical under-confidence due to their perceived specialist nature.

This article examines definitions of CKD, some key considerations in the clinical approach to a patient with CKD, including history and examination findings, and provides a brief overview of renal replacement strategies for the patient with ESKD. The article concludes with an overview of prescribing considerations for the patient with CKD.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content