Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Background – Chronic Kidney Disease
  • Chronic kidney disease (CKD) is defined as kidney damage or a glomerular filtration rate of < 60ml/ min/1.73m2 for three or more months, irrespective of cause (Canadian Society of Nephrology [CSN], 2007; Levey et al., 2003)
  • Though serum creatinine levels may be used to assess kidney function, when used alone they are an inaccurate marker.
  • The eGFR is a calculation used to estimate the volume of fluid the kidneys filter based on a standard body mass index.
  • CKD is divided into five stages (Manifestations of CKD will vary among individuals):
     
    *eGFR may be calculated by some laboratories, reported differently according to institution/setting, or may not be reported at all. Serum creatinine and a calculated eGFR together provide a better indication of kidney function. The Calculated/Estimated Glomerular Filtration Rate is reported in ml/min/1.73m2.
     
    1. Kidney damage with normal or increased eGFR
      • Manifestations: Few symptoms experiences; Some changes to lab values ( serum urea and creatinine); Estimated eGFR is > 90
      • Actions: Diagnosis and treatment, treatment of co-morbid conditions, slowing progression, Cardio Vascular Disease risk reduction
    2. Kidney damage with mildly decreased eGFR
      • Manifestations: Few symptoms experiences; Some changes to lab values ( serum urea and creatinine); Estimated eGFR is 60-90
      • Actions: Estimating progression
    3. Moderately decreased eGFR
      • Manifestations: Symptoms may be experiences; Increase in laboratory values abnormalities; Estimated eGFR is 30-60
      • Actions: Evaluating and treating complications
    4. Severely decreased eGFR
      • Manifestations: Increased in symptoms of uremia; Increase in laboratory values abnormalities; Estimated eGFR is 15-30
      • Actions: Preparation for kidney replacement therapy
    5. Kidney Failure Often referred to as ESRD
      • Manifestations: Decision required around treatment options; Elevated urea and creatinine; estimated eGFR is < 15
      • Actions: Replacement (if uremia present)
  • Leading causes of CKD include diabetes (34.4%), vascular disease (19.5%), unknown cause (12.9%) and glomerulonephritis (11.6%) (CIHI, 2008).
  • CKD is a progressive disease that may be viewed along a continuum. At present, there is no cure. CKD management focuses on early detection and treatment that may delay or slow the rate of progression and reduce the incidence of adverse health outcomes. One of the goals in the treatment of CKD is to provide patients with the education and support needed in order to encourage active participation in their care.