Staging & Causes
GFR: Stage 1 (>=90), 2 (60-89), 3a (45-59), 3b (30-44), 4 (15-29), 5 (<15). Causes: diabetes (most common), HTN, glomerulonephritis, PKD. Early detection slows progression.
Complications
Fluid overload, hyperkalemia, hyperphosphatemia, hypocalcemia, metabolic acidosis, anemia (low EPO), bone disease, uremic symptoms (fatigue, nausea, pruritus), cardiovascular disease (leading cause of death).
Nursing Management
BP <130/80 with ACE/ARB (renoprotective). Glycemic control. Protein restriction 0.6-0.8 g/kg/day. Phosphate restriction + binders. K+ restriction. Fluid restriction. ESA for anemia (Hgb 10-11.5). Vitamin D. Prepare for RRT.
Important Notes
- CKD patients have significantly increased CV risk — statin therapy for all CKD patients over 50.
- NSAIDs contraindicated in CKD — they reduce renal blood flow and accelerate progression.
Clinical Tips
- ACE/ARBs renoprotective and reduce proteinuria — but monitor creatinine and K+ after starting.
- Iron deficiency must be corrected before ESA therapy — check ferritin and TSAT.
Summary
CKD management requires BP/glycemic control, dietary restrictions, anemia management, and preparation for renal replacement therapy.
