Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive loss of renal function The kidneys are paired organs with several functions. They are seen in many types of animals, including vertebrates and some invertebrates. They are an essential part of the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid-base balance, and regulation of blood pressure. They serve the over a period of months or years. The symptoms of worsening kidney function are unspecific, and might include feeling generally unwell Malaise is a feeling of general discomfort or uneasiness, an "out of sorts" feeling, often the first indication of an infection or other disease. Malaise is often defined in medicinal research as a "general feeling of being unwell" and experiencing a reduced appetite Anorexia (deriving from the Greek "α-" (a(n)-, a prefix that denotes absence) + "όρεξη" (orexe) = appetite) is the decreased sensation of appetite. While the term in non-scientific publications is often used interchangeably with anorexia nervosa, many possible causes exist for a decreased appetite, some of which may be. Often, chronic kidney disease is diagnosed as a result of screening Screening, in medicine, is a strategy used in a population to detect a disease in individuals without signs or symptoms of that disease. Unlike what generally happens in medicine, in screening tests are performed on persons without any clinical sign of disease of people known to be at risk of kidney problems, such as those with high blood pressure Hypertension or high blood pressure is a chronic medical condition in which the blood pressure in the arteries is elevated. It is the opposite of hypotension. It is classified as either primary (essential) or secondary. About 90-95% of cases are termed "primary hypertension", which refers to high blood pressure for which no medical cause or diabetes Diabetes mellitus —often simply referred to as diabetes—is a condition in which a person has a high blood sugar (glucose) level, either because the body doesn't produce enough insulin, or because body cells don't properly respond to the insulin that is produced. Insulin is a hormone produced in the pancreas which enables body cells to absorb and those with a blood relative with chronic kidney disease. Chronic kidney disease may also be identified when it leads to one of its recognized complications, such as cardiovascular disease Heart disease or cardiovascular diseases is the class of diseases that involve the heart or blood vessels . While the term technically refers to any disease that affects the cardiovascular system (as used in MeSH C14), it is usually used to refer to those related to atherosclerosis (arterial disease). These conditions have similar causes,, anemia Anemia is a decrease in normal number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin deficiency or pericarditis Pericarditis is an inflammation of the pericardium (the fibrous sac surrounding the heart).^[1]

Chronic kidney disease is identified by a blood test A blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick for creatinine. Higher levels of creatinine indicate a falling glomerular filtration rate Renal function, in nephrology, is an indication of the state of the kidney and its role in renal physiology. Glomerular filtration rate describes the flow rate of filtered fluid through the kidney. Creatinine clearance rate (CCr) is the volume of blood plasma that is cleared of creatinine per unit time and is a useful measure for approximating the and as a result a decreased capability of the kidneys to excrete waste products. Creatinine levels may be normal in the early stages of CKD, and the condition is discovered if urinalysis A urinalysis is an array of tests performed on urine and one of the most common methods of medical diagnosis. A part of a urinalysis can be performed by using urine dipsticks, in which the test results can be read as color changes (testing of a urine sample) shows that the kidney is allowing the loss of protein Proteins are organic compounds made of amino acids arranged in a linear chain and folded into a globular form. The amino acids in a polymer are joined together by the peptide bonds between the carboxyl and amino groups of adjacent amino acid residues. The sequence of amino acids in a protein is defined by the sequence of a gene, which is encoded or red blood cells Red blood cells are the most common type of blood cell and the vertebrate organism's principal means of delivering oxygen (O2) to the body tissues via the blood flow through the circulatory system. They take up oxygen in the lungs or gills and release it while squeezing through the body's capillaries into the urine. To fully investigate the underlying cause of kidney damage, various forms of medical imaging Medical imaging is the technique and process used to create images of the human body for clinical purposes (medical procedures seeking to reveal, diagnose or examine disease) or medical science (including the study of normal anatomy and physiology). Although imaging of removed organs and tissues can be performed for medical reasons, such, blood tests and often renal biopsy A biopsy is a medical test involving the removal of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically. When an entire lump or suspicious area is (removing a small sample of kidney tissue) are employed to find out if there is a reversible cause for the kidney malfunction.^[1] Recent professional guidelines classify the severity of chronic kidney disease in five stages, with stage 1 being the mildest and usually causing few symptoms and stage 5 being a severe illness with poor life expectancy if untreated. Stage 5 CKD is also called established chronic kidney disease and is synonymous with the now outdated terms end-stage renal disease (ESRD), chronic kidney failure (CKF) or chronic renal failure (CRF).^[1]

There is no specific treatment unequivocally shown to slow the worsening of chronic kidney disease. If there is an underlying cause to CKD, such as vasculitis Vasculitis refers to a heterogeneous group of disorders that are characterized by inflammatory destruction of blood vessels. Both arteries and veins are affected. Lymphangitis is sometimes considered a type of vasculitis. Vasculitis is primarily due to leukocyte migration and resultant damage, this may be treated directly with treatments aimed to slow the damage. In more advanced stages, treatments may be required for anemia and bone disease Renal osteodystrophy or chronic kidney disease-mineral and bone disorder is a bone pathology, characterized by bone mineralization deficiency, that is a direct result of the electrolyte and endocrine derangements which accompany chronic kidney disease. Renal osteodystrophy can be further divided into metabolic states associated with either high or. Severe CKD requires one of the forms of renal replacement therapy These treatments do not cure chronic kidney disease; they are palliative treatments. Early dialysis in acute renal failure may have favourable outcomes and bring resolution of renal failure; this may be a form of dialysis In medicine, dialysis is primarily used to provide an artificial replacement for lost kidney function in people with renal failure. Dialysis may be used for those with an acute disturbance in kidney function (acute kidney injury, previously acute renal failure) or for those with progressive but chronically worsening kidney function–a state known, but ideally constitutes a kidney transplant Kidney transplantation or renal transplantation is the organ transplant of a kidney into a patient with end-stage renal disease. Kidney transplantation is typically classified as deceased-donor or living-donor transplantation depending on the source of the donor organ. Living-donor renal transplants are further characterized as genetically related.^[1]

Signs and symptoms

CKD is initially without specific symptoms and can only be detected as an increase in serum creatinine or protein in the urine. As the kidney The kidneys are paired organs with several functions. They are seen in many types of animals, including vertebrates and some invertebrates. They are an essential part of the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid-base balance, and regulation of blood pressure. They serve the function decreases:

• blood pressure Blood pressure is a force exerted by circulating blood on the walls of blood vessels, and is one of the principal vital signs. During each heartbeat, BP varies between a maximum (systolic) and a minimum (diastolic) pressure. The mean BP, due to pumping by the heart and resistance in blood vessels, decreases as the circulating blood moves away from is increased due to fluid overload and production of vasoactive hormones, increasing one's risk of developing hypertension Hypertension or high blood pressure is a chronic medical condition in which the blood pressure in the arteries is elevated. It is the opposite of hypotension. It is classified as either primary (essential) or secondary. About 90-95% of cases are termed "primary hypertension", which refers to high blood pressure for which no medical cause and/or suffering from congestive heart failure Heart failure is a condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs. The phrase is often incorrectly used to describe other cardiac-related illnesses, such as myocardial infarction (heart attack) or cardiac arrest
• Urea Urea or carbamide is an organic compound with the chemical formula (N accumulates, leading to azotemia Azotemia is a medical condition characterized by abnormally high levels of nitrogen-containing compounds, such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds in the blood. It is largely related to insufficient filtering of blood by the kidneys and ultimately uremia Uremia or uraemia is a term used to loosely describe the illness accompanying kidney failure (also called renal failure), in particular the nitrogenous waste products associated with the failure of this organ (symptoms ranging from lethargy to pericarditis Pericarditis is an inflammation of the pericardium (the fibrous sac surrounding the heart) and encephalopathy Encephalopathy /ɛnˌsɛfəˈlɒpəθi/ literally means disorder or disease of the brain. In modern usage, encephalopathy does not refer to a single disease, but rather to a syndrome of global brain dysfunction; this syndrome can be caused by many different illnesses). Urea is excreted by sweating and crystallizes on skin ("uremic frost").
• Potassium Potassium is the chemical element with the symbol K (Latin: kalium, from Arabic: القَلْيَه‎ al-qalyah "plant ashes" cf. Alkali from the same root, more commonly known in Modern Standard Arabic as بوتاسيوم ‹bwtasywm›), atomic number 19, and atomic mass 39.0983. Potassium was first isolated from potash. Elemental accumulates in the blood (known as hyperkalemia Hyperkalemia refers to the condition in which the concentration of potassium (K+) in the blood is an elevated blood level of the electrolyte potassium. Extreme hyperkalemia is a medical emergency due to the risk of potentially fatal abnormal heart rhythms (arrhythmia). The prefix hyper- means high (contrast with hypo-, meaning low). Kal refers to with a range of symptoms including malaise Malaise is a feeling of general discomfort or uneasiness, an "out of sorts" feeling, often the first indication of an infection or other disease. Malaise is often defined in medicinal research as a "general feeling of being unwell" and potentially fatal cardiac arrhythmias Cardiac dysrhythmia is a term for any of a large and heterogeneous group of conditions in which there is abnormal electrical activity in the heart. The heart beat may be too fast or too slow, and may be regular or irregular)
• Erythropoietin Erythropoietin, or its alternatives erythropoetin or erithropoyetin or EPO, is a glycoprotein hormone that controls erythropoiesis, or red blood cell production. It is a cytokine for erythrocyte (red blood cell) precursors in the bone marrow synthesis is decreased (potentially leading to anemia Anemia is a decrease in normal number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin deficiency, which causes fatigue Fatigue is a state of awareness. It can describe a range of afflictions, varying from a general state of lethargy to a specific work-induced burning sensation within one's muscles. It can be both physical and mental. Physical fatigue is the inability to continue functioning at the level of one's normal abilities. It is ubiquitous in everyday life,)
• Fluid volume overload Fluid balance is the concept of human homeostasis that the amount of fluid lost from the body is equal to the amount of fluid taken in. Euvolemia is the state of normal body fluid volume - symptoms may range from mild edema Edema or oedema (British English; both words from the Greek οἴδημα, oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body. Generally, the amount of interstitial fluid is determined by the balance of fluid homeostasis, and increased to life-threatening pulmonary edema Pulmonary edema , or oedema (British English; both words from the Greek οἴδημα), is fluid accumulation in the lungs. It leads to impaired gas exchange and may cause respiratory failure. It is due to either failure of the heart to remove fluid from the lung circulation ("cardiogenic pulmonary edema") or a direct injury to the lung
• Hyperphosphatemia Hyperphosphatemia is an electrolyte disturbance in which there is an abnormally elevated level of phosphate in the blood. Often, calcium levels are lowered due to precipitation of phosphate with the calcium in tissues - due to reduced phosphate excretion, associated with hypocalcemia In medicine, hypocalcemia is the presence of low serum calcium levels in the blood, usually taken as less than 2.1 mmol/L or 9 mg/dl or an ionized calcium level mm of less than 1.1 mmol/L . It is a type of electrolyte disturbance. In the blood, about half of all calcium is bound to proteins such as serum albumin, but it is the unbound, or ionized, (due to vitamin D3 It is structurally similar to steroids such as testosterone, cholesterol, and cortisol deficiency). The major sign of hypocalcemia being tetany Tetany is a medical sign, the involuntary contraction of muscles, caused by diseases and other conditions that increase the action potential frequency. The muscle cramps caused by the disease tetanus are not classified as tetany; rather, they are due to a blocking of the inhibition to the neurons that supply muscles.
  • Later this progresses to tertiary hyperparathyroidism Tertiary hyperparathyroidism is a state of excessive secretion of parathyroid hormone after a long period of secondary hyperparathyroidism and resulting hypercalcemia. It reflects development of autonomous (unregulated) parathyroid function following a period of persistent parathyroid stimulation, with hypercalcaemia Hypercalcaemia is an elevated calcium level in the blood. (Normal range: 9-10.5 mg/dL or 2.2-2.6 mmol/L). It can be an asymptomatic laboratory finding, but because an elevated calcium level is often indicative of other diseases, a diagnosis should be undertaken if it persists. It can be due to excessive skeletal calcium release, increased, renal osteodystrophy Renal osteodystrophy or chronic kidney disease-mineral and bone disorder is a bone pathology, characterized by bone mineralization deficiency, that is a direct result of the electrolyte and endocrine derangements which accompany chronic kidney disease. Renal osteodystrophy can be further divided into metabolic states associated with either high or and vascular calcification that further impairs cardiac function.
• Metabolic acidosis In medicine, metabolic acidosis is a process that, if unchecked, leads to acidemia, i.e., blood pH is low due to increased production of H+ by the body or the inability of the body to form bicarbonate (HCO3-) in the kidney. Its causes are diverse, and its consequences can be serious, including coma and death. Together with respiratory acidosis, it, due to accumulation of sulfates, phosphates, uric acid etc. This may cause altered enzyme activity by excess acid acting on enzymes and also increased excitability of cardiac and neuronal membranes by the promotion of hyperkalemia Hyperkalemia refers to the condition in which the concentration of potassium (K+) in the blood is an elevated blood level of the electrolyte potassium. Extreme hyperkalemia is a medical emergency due to the risk of potentially fatal abnormal heart rhythms (arrhythmia). The prefix hyper- means high (contrast with hypo-, meaning low). Kal refers to due to excess acid (acidemia Acidosis is an increased acidity in the blood. . If not further qualified, it usually refers to acidity of the blood plasma)^[2]

People with chronic kidney disease suffer from accelerated atherosclerosis and are more likely to develop cardiovascular disease than the general population. Patients afflicted with chronic kidney disease and cardiovascular disease tend to have significantly worse prognoses than those suffering only from the latter.

Diagnosis

In many CKD patients, previous renal disease or other underlying diseases are already known. A small number presents with CKD of unknown cause. In these patients, a cause is occasionally identified retrospectively.^{[citation needed]}

It is important to differentiate CKD from acute renal failure (ARF) because ARF can be reversible. Abdominal ultrasound is commonly performed, in which the size of the kidneys are measured. Kidneys with CKD are usually smaller (< 9 cm) than normal kidneys with notable exceptions such as in diabetic nephropathy and polycystic kidney disease. Another diagnostic clue that helps differentiate CKD and ARF is a gradual rise in serum creatinine (over several months or years) as opposed to a sudden increase in the serum creatinine (several days to weeks). If these levels are unavailable (because the patient has been well and has had no blood tests) it is occasionally necessary to treat a patient briefly as having ARF until it has been established that the renal impairment is irreversible.^{[citation needed]}

Additional tests may include nuclear medicine MAG3 scan to confirm blood flows and establish the differential function between the two kidneys. DMSA scans are also used in renal imaging; with both MAG3 and DMSA being used chelated with the radioactive element Technetium-99.^{[citation needed]}

In chronic renal failure treated with standard dialysis, numerous uremic toxins accumulate. These toxins show various cytotoxic activities in the serum, have different molecular weights and some of them are bound to other proteins, primarily to albumin. Such toxic protein bound substances are receiving the attention of scientists who are interested in improving the standard chronic dialysis procedures used today.^{[citation needed]}

Stages

All individuals with a Glomerular filtration rate (GFR) <60 mL/min/1.73 m² for 3 months are classified as having chronic kidney disease, irrespective of the presence or absence of kidney damage. The rationale for including these individuals is that reduction in kidney function to this level or lower represents loss of half or more of the adult level of normal kidney function, which may be associated with a number of complications.^[1]

All individuals with kidney damage are classified as having chronic kidney disease, irrespective of the level of GFR. The rationale for including individuals with GFR 60 mL/min/1.73 m² is that GFR may be sustained at normal or increased levels despite substantial kidney damage and that patients with kidney damage are at increased risk of the two major outcomes of chronic kidney disease: loss of kidney function and development of cardiovascular disease.^[1]

The loss of protein in the urine is regarded as an independent marker for worsening of renal function and cardiovascular disease. Hence, British guidelines append the letter "P" to the stage of chronic kidney disease if there is significant protein loss.^[3]

Stage 1 CKD

Slightly diminished function; Kidney damage with normal or relatively high GFR (>90 mL/min/1.73 m²). Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine test or imaging studies.^[1]

Stage 2 CKD

Mild reduction in GFR (60-89 mL/min/1.73 m²) with kidney damage. Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine test or imaging studies.^[1]

Stage 3 CKD

Moderate reduction in GFR (30-59 mL/min/1.73 m²).^[1] British guidelines distinguish between stage 3A (GFR 45-59) and stage 3B (GFR 30-44) for purposes of screening and referral.^[3]

Stage 4 CKD

Severe reduction in GFR (15-29 mL/min/1.73 m²)^[1] Preparation for renal replacement therapy

Stage 5 CKD

Established kidney failure (GFR <15 mL/min/1.73 m², or permanent renal replacement therapy (RRT)^[1]

Causes

The most common causes of CKD are diabetic nephropathy, hypertension, and glomerulonephritis. Together, these cause approximately 75% of all adult cases. Certain geographic areas have a high incidence of HIV nephropathy.^{[citation needed]}

Historically, kidney disease has been classified according to the part of the renal anatomy that is involved, as:^{[citation needed]}

• Vascular, includes large vessel disease such as bilateral renal artery stenosis and small vessel disease such as ischemic nephropathy, hemolytic-uremic syndrome and vasculitis
• Glomerular, comprising a diverse group and subclassified into
  • Primary Glomerular disease such as focal segmental glomerulosclerosis and IgA nephritis
  • Secondary Glomerular disease such as diabetic nephropathy and lupus nephritis
• Tubulointerstitial including polycystic kidney disease, drug and toxin-induced chronic tubulointerstitial nephritis and reflux nephropathy
• Obstructive such as with bilateral kidney stones and diseases of the prostate

Treatment

The goal of therapy is to slow down or halt the otherwise relentless progression of CKD to stage 5. Control of blood pressure and treatment of the original disease, whenever feasible, are the broad principles of management. Generally, angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II receptor antagonists (ARBs) are used, as they have been found to slow the progression of CKD to stage 5.^[4][5] Although the use of ACE inhibitors and ARBs represents the current standard of care for patients with CKD, patients progressively lose kidney function while on these medications, as seen in the IDNT^[6] and RENAAL^[7] studies, which reported a decrease over time in estimated glomerular filtration rate (an accurate measure of CKD progression, as detailed in the K/DOQI guidelines^[1]) in patients treated by these conventional methods.

Currently, several compounds are in development for CKD. These include, but are not limited to, bardoxolone methyl^[8], olmesartan medoxomil, sulodexide, and avosentan^[9].

Replacement of erythropoietin and vitamin D3, two hormones processed by the kidney, is usually necessary in patients with CKD, as is calcium. Phosphate binders are used to control the serum phosphate levels, which are usually elevated in chronic kidney disease.

When one reaches stage 5 CKD, renal replacement therapy is required, in the form of either dialysis or a transplant.

In some cases, dietary modifications have been proven to slow and even reverse further progression. Generally this includes limiting a persons intake of protein.^{[citation needed]}

The normalization of hemoglobin has not been found to be of any benefit.^[10]

Prognosis

The prognosis of patients with chronic kidney disease is guarded as epidemiological data has shown that all cause mortality (the overall death rate) increases as kidney function decreases.^[11] The leading cause of death in patients with chronic kidney disease is cardiovascular disease, regardless of whether there is progression to stage 5.^[11][12][13]

While renal replacement therapies can maintain patients indefinitely and prolong life, the quality of life is severely affected.^[14][15] Renal transplantation increases the survival of patients with stage 5 CKD significantly when compared to other therapeutic options;^[16][17] however, it is associated with an increased short-term mortality (due to complications of the surgery). Transplantation aside, high intensity home hemodialysis appears to be associated with improved survival and a greater quality of life, when compared to the conventional three times a week hemodialysis and peritoneal dialysis.^[18]

Epidemiology

In Canada 1.9 to 2.3 million people have chronic kidney disease.^[19]

UK estimates suggest that 8.8% of the population of Great Britain and Northern Ireland have symptomatic CKD. ^[20]

Organizations

In the USA, the National Kidney Foundation is a national organization representing patients and professionals who treat kidney diseases. The American Kidney Fund (AKF) is a national non-profit organization providing treatment-related financial assistance to 1 out of every 5 dialysis patients each year. The Renal Support Network (RSN) is a nonprofit, patient-focused, patient-run organization that provides non-medical services to those affected by CKD. The American Association of Kidney Patients (AAKP) is a non-profit, patient-centric group focused on improving the health and well-being of CKD and dialysis patients. The Renal Physicians Association (RPA) is an association representing nephrology professionals.

In the United Kingdom, the UK National Kidney Federation represents patients, and the Renal Association represents renal physicians and works closely with the National Service Framework for kidney disease.

The International Society of Nephrology is an international body representing specialists in kidney diseases.

See also

• Acute renal failure
• Dialysis
• Hepatorenal syndrome
• Renal failure
• Artificial kidney

References

Find more about Chronic kidney disease on Wikipedia's sister projects:

1. ^ ^{a b c d e f g h i j k l} National Kidney Foundation (2002). "K/DOQI clinical practice guidelines for chronic kidney disease". http://www.kidney.org/professionals/KDOQI/guidelines_ckd. Retrieved 2008-06-29.
2. ^ Adrogué HJ, Madias NE (September 1981). "Changes in plasma potassium concentration during acute acid-base disturbances". Am. J. Med. 71 (3): 456–67. doi:10.1016/0002-9343(81)90182-0. PMID 7025622.
3. ^ ^{a b} National Institute for Health and Clinical Excellence. Clinical guideline 73: Chronic kidney disease. London, 2008.
4. ^ Ruggenenti P, Perna A, Gherardi G, Gaspari F, Benini R, Remuzzi G (October 1998). "Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Ramipril Efficacy in Nephropathy". Lancet 352 (9136): 1252–6. doi:10.1016/S0140-6736(98)04433-X. PMID 9788454.
5. ^ Ruggenenti P, Perna A, Gherardi G, et al. (July 1999). "Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria". Lancet 354 (9176): 359–64. doi:10.1016/S0140-6736(98)10363-X. PMID 10437863.
6. ^ Lewis EJ, Hunsicker LG, Clarke WR, et al. (2001). "Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes". N Engl J Med 345: 851–60.
7. ^ Brenner BM, Cooper ME, de ZD, et al. (2001). "Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy". N Engl J Med 345: 861–9.
8. ^ http://www.medscape.com/viewarticle/590644
9. ^ http://www.medicalnewstoday.com/articles/139028.php
10. ^ Levin A, Hemmelgarn B, Culleton B, et al. (November 2008). "Guidelines for the management of chronic kidney disease". CMAJ 179 (11): 1154–62. doi:10.1503/cmaj.080351. PMID 19015566.
11. ^ ^{a b} Perazella MA, Khan S (March 2006). "Increased mortality in chronic kidney disease: a call to action". Am. J. Med. Sci. 331 (3): 150–3. doi:10.1097/00000441-200603000-00007. PMID 16538076.
12. ^ Sarnak MJ, Levey AS, Schoolwerth AC, et al. (October 2003). "Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention". Circulation 108 (17): 2154–69. doi:10.1161/01.CIR.0000095676.90936.80. PMID 14581387. http://circ.ahajournals.org/cgi/content/full/108/17/2154.
13. ^ Tonelli M, Wiebe N, Culleton B, et al. (July 2006). "Chronic kidney disease and mortality risk: a systematic review". J. Am. Soc. Nephrol. 17 (7): 2034–47. doi:10.1681/ASN.2005101085. PMID 16738019. http://jasn.asnjournals.org/cgi/content/full/17/7/2034.
14. ^ Heidenheim AP, Kooistra MP, Lindsay RM (2004). "Quality of life". Contrib Nephrol 145: 99–105. doi:10.1159/000081673. PMID 15496796.
15. ^ de Francisco AL, Piñera C (January 2006). "Challenges and future of renal replacement therapy". Hemodial Int 10 Suppl 1: S19–23. doi:10.1111/j.1542-4758.2006.01185.x. PMID 16441862.
16. ^ Groothoff JW (July 2005). "Long-term outcomes of children with end-stage renal disease". Pediatr. Nephrol. 20 (7): 849–53. doi:10.1007/s00467-005-1878-9. PMID 15834618.
17. ^ Giri M (2004). "Choice of renal replacement therapy in patients with diabetic end stage renal disease". Edtna Erca J 30 (3): 138–42. PMID 15715116.
18. ^ Pierratos A, McFarlane P, Chan CT (March 2005). "Quotidian dialysis--update 2005". Curr. Opin. Nephrol. Hypertens. 14 (2): 119–24. PMID 15687837.
19. ^ Levin A, Hemmelgarn B, Culleton B, et al. (November 2008). "Guidelines for the management of chronic kidney disease". CMAJ 179 (11): 1154–62. doi:10.1503/cmaj.080351. PMID 19015566.
20. ^ The Association of Public Health Observatories – Chronic Kidney Disease Prevalence Estimates. 2007 [cited 1/3/2010]; Available from: http://www.apho.org.uk/resource/item.aspx?RID=63798.

External links

• National Kidney Foundation
• Renal Failure, Chronic and Dialysis Complications - emedicine.com

Categories: Nephrology | Kidney diseases | Organ failure

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