Chronic renal failure natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]
Overview
Chronic renal failure can be complicated by the development of disorders such as hyperuricemia, myopathy, congestive heart failure, pallor, nausea, anorexia, and peptic ulcers amongst other disorders. The prognosis of the disease is poor if mismanaged. If untreated, chronic renal failure (CRF) will progress to end-stage renal disease, which has a high morbidity rate.
Natural History
A population-based study of a Swedish cohort of with pre-existing stage 4 or 5 CKD showed that 80% of patients would progress to require RRT within 5 years, with a mortality rate of up to 39%. Half of the cohort was on renal replacement by 18 months follow up.[1] Usually, the time frame of progression to ESRD is very variable among individuals. Older age, male gender, and African American ethnicity are all associated with higher risk of progression. Tight blood pressure and glycemic control are essential to decrease the risk of development of ESRD in patients with pre-existing renal insufficiency.[2]
Complications
Stages of Chronic Kidney Diseases
The stages of CKD is based on the GFR and other renal function abnormalities. The different stages of chronic kidney diseases are as follow:
- Stage 1: GFR>90 ml/min/1.73m2 and evidence of kidney damage
- Stage 2: GFR 60-89 ml/min/1.73m2 and evidence of kidney damage
- Stage 3: GFR 30-59 ml/min/1.73m2
- Stage 4: GFR 15-29 ml/min/1.73m2
- Stage 5: GFR <15 ml/min/1.73m2
ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT) [3]
Recommendations for End-Stage Renal Failure
| Class I |
| "1. The acute management of ventricular arrhythmias in end-stage renal failure should immediately address hemodynamic status and electrolyte (potassium, magnesium, and calcium) imbalance. (Level of Evidence: C)" |
| "2. Life-threatening ventricular arrhythmias, especially in patients awaiting renal transplantation, should be treated conventionally, including the use of ICD and pacemaker as required, in patients who are receiving chronic optimal medical therapy and who have reasonable expectation of survival with a good functional status for more than 1 y. (Level of Evidence: C)" |
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.[4] The leading cause of death in patients with chronic kidney disease is cardiovascular disease, regardless of whether there is progression to ESRD.[4][5][6]
While renal replacement therapies can maintain patients indefinitely and prolong life, the quality of life of the patient is severely affected.[7][8] Renal transplantation increases the survival of patients with ESRD significantly when compared to other therapeutic options;[9][10] 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 thrice weekly hemodialysis and peritoneal dialysis.[11]
References
- ↑ Evans M, Fryzek JP, Elinder CG, Cohen SS, McLaughlin JK, Nyrén O; et al. (2005). "The natural history of chronic renal failure: results from an unselected, population-based, inception cohort in Sweden". Am J Kidney Dis. 46 (5): 863–70. doi:10.1053/j.ajkd.2005.07.040. PMID 16253726. Review in: Evid Based Med. 2006 Aug;11(4):118
- ↑ Taal MW, Brenner BM (2006). "Predicting initiation and progression of chronic kidney disease: Developing renal risk scores". Kidney Int. 70 (10): 1694–705. doi:10.1038/sj.ki.5001794. PMID 16969387.
- ↑ Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M; et al. (2006). "ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation. 114 (10): e385–484. doi:10.1161/CIRCULATIONAHA.106.178233. PMID 16935995.
- ↑ 4.0 4.1 Perazella MA, Khan S. Increased mortality in chronic kidney disease: a call to action. Am J Med Sci. 2006 Mar;331(3):150-3. PMID 16538076.
- ↑ Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, McCullough PA, Kasiske BL, Kelepouris E, Klag MJ, Parfrey P, Pfeffer M, Raij L, Spinosa DJ, Wilson PW; American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. 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. 2003 Oct 28;108(17):2154-69. PMID 14581387. Free Full Text.
- ↑ Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M, McAlister F, Garg AX. Chronic Kidney Disease and Mortality Risk: A Systematic Review. J Am Soc Nephrol. 2006 May 31; PMID 16738019.
- ↑ Heidenheim AP, Kooistra MP, Lindsay RM. Quality of life. Contrib Nephrol. 2004;145:99-105. PMID 15496796.
- ↑ de Francisco AL, Pinera C. Challenges and future of renal replacement therapy. Hemodial Int. 2006 Jan;10 Suppl 1:S19-23. PMID 16441862.
- ↑ Groothoff JW. Long-term outcomes of children with end-stage renal disease. Pediatr Nephrol. 2005 Jul;20(7):849-53. Epub 2005 Apr 15. PMID 15834618.
- ↑ Giri M. Choice of renal replacement therapy in patients with diabetic end stage renal disease. EDTNA ERCA J. 2004 Jul-Sep;30(3):138-42. PMID 15715116.
- ↑ Pierratos A, McFarlane P, Chan CT. Quotidian dialysis--update 2005. Curr Opin Nephrol Hypertens. 2005 Mar;14(2):119-24. PMID 15687837.