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Continuing Education

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Chronic Kidney Disease Acute Manifestations and Role of Critical Care Nurses Sharon K. Broscious, RN, DSN, CCRN Judith Castagnola, RN, MSN

D

espite the improved diagnosis and treatment of kidney disease, late diagnosis with resultant permanent damage to the kidneys still occurs. A work group established by the National Kidney Foundation, the Kidney Disease Outcome Quality Initiative (KDOQI), was asked to develop clinical practice guidelines and a uniform classification system for chronic kidney disease (CKD). CKD is a public health issue because of its increasing incidence and the high cost of interventions.1 An additional concern is the increasing incidence of kidney disease in African Americans and Native Americans.2 According to the 2004 report from the US Renal Data System,3 the number of patients with CKD receiving therapy in 2002 was 431284. This number is a 4.6% increase over the number for the year 2001. The adjusted rate for CKD was 1435 cases per million population—72% of patients were undergoing dialysis;

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the other 122374 had a functioning transplant. The adjusted rate of CKD for the white population was 1060 cases per million; for the African American population, 4467 cases per million; and for the Native American population, 2569 cases per million. In 2002, Medicare expenses for CKD treatment increased 11% over the level in 2001; Medicare expenses were $17 billion and non-Medicare expenses were $8.2 billion. From the individual perspective, Medicare costs per year are approximately $53000, with deductibles and copayments bringing the total to $63000 per year. Total cost for the entire CKD program was approximately $25.2 billion at the end of 2002.3 The KDOQI has identified 5 stages of kidney failure (Table 1) on the basis of glomerular filtration rate (GFR).4 Normal GFR in men is 125 to 150 mL/min per 1.73 m2 (1.73 m2 is considered the standard normal body surface area). Chronic kidney failure

* This article has been designated for CE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives: 1. Identify the expected outcomes of patients with chronic kidney disease (CKD) 2. Describe the pathophysiology of CKD 3. Discuss the impact of CKD in relation to body systems

Authors Sharon K. Broscious is an associate professor in the School of Nursing at Troy University, Atlantic Region, in Norfolk, Va. Judith Castagnola is a facility administrator at DaVita Peninsula Dialysis in Newport News, Va. Corresponding author: Sharon K. Broscious, Troy University, Atlantic Region, 5425 Robin Hood Rd, Ste B1, Norfolk, VA 23513. (e-mail: [email protected]) To purchase electronic or print reprints, contact The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 809-2273 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, [email protected].

CRITICALCARENURSE Vol 26, No. 4, AUGUST 2006 17

Table 1 Chronic kidney disease defined by the National Kidney Foundation* Stage

Description

Glomerular filtration rate (GFR), mL/min per 1.73 m2 >90

1

Kidney damage with normal or increased GFR

2

Kidney damage with mild decrease in GFR

60-89

3

Moderate decrease in GFR

30-59

4

Severe decrease in GFR

5

Kidney failure

15-29