Chronic kidney disease: acute manifestations and role of critical care nurses.

Judith Castagnola is a facility administrator at DaVita Peninsula Dialysis in Newport News, Va. Despite 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. An additional concern is the increasing incidence of kidney disease in African Americans and Native Americans. According to the 2004 report from the US Renal Data System, 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; 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. The KDOQI has identified 5 stages of kidney failure (Table 1) on the basis of glomerular filtration rate (GFR). 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 Chronic Kidney Disease Acute Manifestations and Role of Critical Care Nurses CoverArticle