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

10 February 2022
27 min read
Volume 31 · Issue 3

Abstract

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.

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