CKD Definition & Staging
CKD: GFR <60 mL/min/1.73m² for >3 months OR evidence of kidney damage. KDIGO Staging: Stage 1 (G1): GFR ≥90; Stage 2 (G2): 60–89; Stage 3a: 45–59; Stage 3b: 30–44; Stage 4: 15–29; Stage 5: <15 or dialysis (ESRD). Common causes: Diabetic nephropathy (#1), Hypertension (#2).
Systemic Complications
Cardiovascular: hypertension, LVH, accelerated atherosclerosis — leading cause of death in CKD. Hematological: normocytic anemia (decreased EPO). Metabolic: hyperkalemia, metabolic acidosis, hyperphosphatemia, hypocalcemia. Neurological: uremic encephalopathy, peripheral neuropathy.
Renal Replacement Therapy
Hemodialysis (HD): blood filtered through artificial kidney 3×/week. Requires AV fistula/graft (never BP or IV in that arm). Peritoneal dialysis (PD): home-based; uses peritoneum as membrane. Kidney transplant: best long-term option; immunosuppression required lifelong.
Nursing Management
Fluid restriction. Dietary: low potassium, low phosphorus, low sodium. Medications: ESA for anemia, phosphate binders (with meals), Vitamin D. Monitor access site (fistula: palpate thrill, auscultate bruit). AV fistula protection: no BP, IV, or tight clothing.
Important Notes
- Never draw blood or take blood pressure in the arm with an AV fistula.
- Hyperkalemia + peaked T waves in CKD patient = cardiac monitoring and immediate treatment.
Clinical Tips
- Renal diet memory: "Keep it LOW" — Low K+, Low PO4, Low Na+, Low fluids.
Summary
CKD is a progressive, systemic disease requiring careful management of fluid, electrolytes, and comorbidities. Nursing focuses on slowing progression and managing complications.
