Handbook of Chronic Kidney Disease Management

Cover
Title Page
Copyright
Contributors
Preface
Contents
1 Assessing Kidney Function
	WHAT THE KIDNEY DOES
		Excretion of Waste Products
		Control of Water, Salt, Other Electrolytes, and Acid–Base (Homeostasis)
		Endocrine and Metabolic Functions
	ANATOMY
		The Nephron: A Glomerulus and a Set of Renal Tubules
	PATHOLOGIC CHANGES WITH KIDNEY DISEASE
		Functional Loss of Glomeruli
		Proteinuria
		Impaired Tubular Function
		Impaired Endocrine and Sympathetic Nervous Function
		Measuring Renal Function
		Concept of Clearance
		Decrease in Normalized Glomerular Filtration Rate With Age
		Measuring Glomerular Filtration Rate With Exogenous Markers
		Estimating Glomerular Filtration Rate by Creatinine Clearance and Serum Creatinine
	PROBLEMS WITH GLOMERULAR FILTRATION RATE ESTIMATES
		Acute Kidney Injury
		Very Lean or Very Obese Patients
	PROTEINURIA
		Anatomy
		Urine Proteins in Health
		Proteinuria in Renal Disease
		Measurement
	STAGING CHRONIC KIDNEY DISEASE
	THE KDIGO CHRONIC KIDNEY DISEASE CLASSIFICATION
	References and Suggested Readings
2 Screening and Management: Overview
	SCREENING
	ONCE CKD HAS BEEN DIAGNOSED, WHAT ADDITIONAL INVESTIGATIONS SHOULD BE ORDERED?
	MANAGEMENT OF PATIENTS WITH CKD
		Smoking and Drug Abuse
		Obesity
		Sodium and Potassium
		Protein Restriction
		Phosphate
		Uric Acid
		Advanced Glycosylation End Products
		Vitamins and Supplements
		Fruit and Vegetables
		Acidosis
		Alcohol
		Cola Beverages
		Fluid Intake
	REDUCING RISK OF PROGRESSION OF CKD AND CARDIOVASCULAR DISEASE
		Lifestyle Modification and Exercise
		Lipid Lowering
		Glycemic Control
		Blood Pressure Control
	PERIPHERAL VASCULAR DISEASE AND STROKE RISK
	CARDIOPROTECTION
	NEPHROTIC RANGE PROTEINURIA
	ANEMIA
	AVOIDING CONTRAST-INDUCED COMPLICATIONS
	MEDICATION REVIEW AND DRUG DOSING IN CKD
	CKD IN SPECIAL POPULATIONS
		Children
		Pregnant Patients
		Elderly
		Other Special Groups
	DETECTION AND MANAGEMENT OF CKD COMPLICATIONS
	WHEN SHOULD CKD PATIENTS BE REFERRED TO A NEPHROLOGIST?
	PREEMPTIVE TRANSPLANTATION, DIALYSIS, OR CONSERVATIVE TREATMENT?
	PRACTICE-RELATED ISSUES, GUIDELINES, AND PATIENT MANAGEMENT AND EDUCATION TOOLS
	References and Suggested Readings
3 Smoking, Substance Abuse, and Environmental Hazards
	SMOKING
		Smoking and Progression of Chronic Kidney Disease
		Smoking in Advanced Stages of Chronic Kidney Disease
		Pathophysiology of Smoking and Chronic Kidney Disease
		Treatment
		Public Health Implications
	ILLICIT DRUGS AND CHRONIC KIDNEY DISEASE
		Heroin
		Cocaine
		Synthetic Cannabinoids
		Methamphetamines
		Ecstasy
		Prescription Opioid Use
		Treatment
		Public Health Implications
	ENVIRONMENTAL HAZARDS AND CHRONIC KIDNEY DISEASE
		Lead
		Cadmium and Mercury
		Arsenic
		Organic Solvents
		Airborne Small Particulate Matter and Organic Pollutants
		Mitigation and Treatment
		Public Health Implications
		Chronic Kidney Disease of Unknown Origin
		Public Health Implications
	References and Suggested Readings
4 Visceral Adiposity and Controlling Body Weight Through Diet and Exercise
	Body Mass Index
	Visceral Adiposity
	Technology-Based Methods for Measuring Body Fat and Visceral Adiposity
	Waist Circumference or Waist–Hip Ratio and Outcomes
	Obesity Microalbuminuria, Albuminuria, and Proteinuria
	Visceral Adiposity, Inflammation, and the Metabolic Syndrome
	WEIGHT-LOSS STRATEGIES IN CHRONIC KIDNEY DISEASE PATIENTS
		Dietary Approaches
		Characteristics of Structured Weight-Loss Programs
		Most Weight-Loss Programs Have Two Phases
		General Effectiveness Versus Risks of Weight-Loss Drugs
		Specific Weight-Loss Drugs
	BARIATRIC SURGERY AND CHRONIC KIDNEY DISEASE
	References and Suggested Readings
5 Sodium and Potassium Intake
	CONTROVERSY OVER RECOMMENDATIONS FOR SODIUM REDUCTION
	CURRENT AVERAGE INTAKES
	BENEFITS OF SODIUM REDUCTION
		Dietary Sodium and Blood Pressure
		Other Benefits of Sodium Reduction
	RECOMMENDED POTASSIUM INTAKE
		Potassium Intake and Blood Pressure
		Potassium Intake and Cardiovascular Disease
		Potassium Intake and Chronic Kidney Disease
	RECOMMENDED SODIUM AND POTASSIUM INTAKES FOR CASE 5.1
		Sodium Intake for Stages 3 and 4 Chronic Kidney Disease
		Potassium Intake for Stages 3 and 4 Chronic Kidney Disease
	POTASSIUM INTAKE IN PATIENTS TAKING POTASSIUM-SPARING DRUGS
		Tools to Assess and Help Ensure Dietary Adherence
		Evaluation of Sodium Intake
	References and Suggested Readings
6 Dietary Sodium and Potassium: A Dietitian’s Perspective
	SODIUM
		Sources of Sodium in the Diet
		An Operational Approach to Controlling Sodium
		At the Market
		In the Kitchen
		At Restaurants and Social Events
		At the Table
		Nutrition Databases for Food Sodium Content
		Specific Recommendations for Sodium Reduction by Meal
	POTASSIUM
		Ranges of Serum Potassium
		Food Labeling for Potassium
		Dietary Potassium Recommendations for Chronic Kidney Disease Patients With Serum Potassium in the Normal Range
		Dietary Potassium Restriction for Chronic Kidney Disease Patients With Serum Potassium in the Caution or Danger Zone
		Potassium Across Various Food Categories
		Potassium in Fruits
		Potassium in Vegetables
		Potassium Content of Foods Other Than Fruits or Vegetables
		Potassium in Salts and Salt Substitutes
	CONCLUSIONS
	References and Suggested Readings
7 Protein Intake
	WHAT ARE THE USUAL PROTEIN REQUIREMENTS AS A FUNCTION OF AGE AND BODY SIZE?
		Minimum Recommended Dietary Allowance for Protein
		Quality of Protein and Essential Amino Acids
	WHAT ARE THE RISKS OF SARCOPENIA AND OSTEOPOROSIS IN THE ELDERLY, AND HOW ARE THESE RELATED TO PROTEIN INTAKE?
		Sarcopenia
		Osteoporosis
	WHAT ARE THE THEORETICAL MECHANISMS WHEREBY REDUCED PROTEIN INTAKE MIGHT SLOW PROGRESSION OF CHRONIC KIDNEY DISEASE?
		Uremic Toxin Production
		Proteinuria Reduction and Slowing of Chronic Kidney Disease Progression
		Phosphate
		Sodium and Blood Pressure
		Lipid Profile
		Insulin Resistance
		Acid Load
	WHAT ARE THE RESULTS OF CLINICAL STUDIES OF THE EFFECTS OF A LOWER-PROTEIN DIET ON CHRONIC KIDNEY DISEASE PROGRESSION?
	WHAT ARE THE RECOMMENDATIONS OF CURRENT GUIDELINES REGARDING PROTEIN INTAKE IN CHRONIC KIDNEY DISEASE?
	USE OF KETOANALOGS OF AMINO ACIDS
	HOW TO ADAPT PROTEIN INTAKE TO THE CHRONIC KIDNEY DISEASE STAGE, AND SHOULD WE FAVOR VEGETABLE PROTEIN?
	DOES PRESENCE OF MARKED PROTEINURIA CHANGE THE RECOMMENDATION FOR PROTEIN RESTRICTION?
	HOW SHOULD ONE MONITOR NUTRITIONAL INTAKE DURING CHRONIC KIDNEY DISEASE?
		Subjective Global Assessment
	URINARY NITROGEN APPEARANCE
	References and Suggested Readings
8 Mineral and Bone Disorders
	PATHOPHYSIOLOGY
		As Glomerular Filtration Rate Falls, the Kidney Needs to Increase Fractional Phosphate Excretion
		Serum FGF23 Levels Rise to Increase Fractional Renal Phosphate Excretion
		Activation of Vitamin D Is Reduced
		In Chronic Kidney Disease, Serum Levels of 25-D Tend to Be Low
		Effect on Parathyroid Hormone
		Parathyroid Hormone Effects on the Kidney in Chronic Kidney Disease
		Summary of Pathophysiology
	BONE DISEASE
		High-Turnover Bone Disease
		Adynamic Bone Disease
		Osteomalacia
		Osteoporosis
		Bone Biopsy
	CARDIOVASCULAR RISK FACTORS ASSOCIATED WITH MINERAL BONE DISORDER OF CHRONIC KIDNEY DISEASE
	LABORATORY TESTS
		Calcium
		Serum Phosphate
		Magnesium
		Serum Parathyroid Hormone
		Serum Alkaline Phosphatase
		Serum 25-D and 1,25-D Assays and Levels
	MONITORING
	TREATMENT STRATEGY
		Restriction of Phosphate Intake
		Control of Serum Phosphate Levels
		Calcium Supplementation
		Vitamin D Supplementation
		Use of Active Vitamin D
		Use of Active Vitamin D Analogs
		Dual Supplementation With Cholecalciferol Plus an Active Form of Vitamin D
		Calcimimetic Drugs
		Phosphorus Binders, Vitamin K, Magnesium, and Vascular Calcification
		Calcium–Alkali Syndrome
	SPECIAL CIRCUMSTANCES
	References and Suggested Readings
9 Restricting Protein and Phosphorus: A Dietitian’s Perspective
	PROTEIN
		High and Low Biologic Value Proteins
		Degree of Protein Restriction
		Building a Low-Protein Diet
		Additional Tips for Patients
	PHOSPHATE
		Phosphate Sources
		Tips Regarding Vegan/Vegetarian Diets
		Inorganic Phosphate
		Food Labels and Other Information Sources on Phosphate Content
		Strategies for Limiting Dietary Phosphate Intake
		Phosphate Binders
	SPECIAL-NEEDS POPULATIONS
		Low and Fixed Income
		Pregnant Chronic Kidney Disease Patients
	SUMMARY
	ADDITIONAL RESOURCES
	References and Suggested Readings
10 Vitamins, Trace Minerals, and Alternative Medicine Supplements
	VITAMINS
		Guidelines Targeting Either the General Population or Non–Chronic Kidney Disease Populations
		Guidelines Focusing on Chronic Kidney Disease Patients
		Summary
	FISH OIL AND OTHER OMEGA-3 FATTY ACIDS
		Fish Oil Supplements and Immunoglobulin A Nephropathy
	MINERALS
		Calcium and Magnesium
		Phosphate in Oral Laxatives
		Aluminum and Citrate
		Fluoride
		Selenium
		Zinc
	COMPLEMENTARY AND ALTERNATIVE MEDICINES AND CHRONIC KIDNEY DISEASE
		Aristolochic Acid
		Lead Contamination of Indian and Nigerian Spices, Ceremonial Powders, and Protein Shakes
	FOODS THAT MAY ADVERSELY AFFECT CHRONIC KIDNEY DISEASE PATIENTS
		Cortinarius Mushroom Toxicity
	FOODS ASSOCIATED WITH INCREASED OXALATE EXCRETION
		Star Fruit
		Chocolate and Tea
		Other Foods
	References and Selected Readings
11 Acid–Base and Electrolyte Disorders
	EXCRETION OF DIETARY ACID LOAD
	RENAL NET ACID EXCRETION
		How the Kidney Reclaims Bicarbonate
		Net Secretion of Acid in the Distal Part of the Renal Tubular System
	EXCRETION OF AMMONIUM
		Estimation of Urinary NH4+ Excretion by Urinary Anion Gap
	METABOLIC ACIDOSIS AND THE SERUM ANION GAP
		Elevated Anion Gap Acidosis
		Normal Anion Gap Acidosis
	ACIDOSIS IN CHRONIC KIDNEY DISEASE
	METABOLIC ALKALOSIS
	METABOLIC ALKALOSIS IN CHRONIC KIDNEY DISEASE
	ELECTROLYTE DISORDERS
		Potassium Regulation and Dyskalemia
		Renal Potassium Regulation
		Hyperkalemia
		Hypokalemia
	WATER REGULATION AND DYSNATREMIA
		Hyponatremia
		Hypernatremia
		Magnesium Regulation and Dysmagnesemia
	References and Suggested Readings
12 Dyslipidemia
	REVIEW OF LIPID ABSORPTION AND METABOLISM
		Lipoproteins
	MEASUREMENT OF LIPIDS AND LIPOPROTEINS
	FACTORS WHICH AFFECT MEASUREMENT OF LIPIDS AND LIPOPROTEINS
	ROLE OF LIPIDS AND LIPOPROTEINS IN ATHEROSCLEROSIS
		Low-Density Lipoprotein
		Triglycerides
		High-Density Lipoprotein
	ALTERATION OF LIPOPROTEIN METABOLISM IN CHRONIC KIDNEY DISEASE AND NEPHROTIC SYNDROME
		Chronic Kidney Disease
		Nephrotic Syndrome
	LIPID-LOWERING THERAPY IN NONDIALYSIS-DEPENDENT CHRONIC KIDNEY DISEASE: CARDIOVASCULAR OUTCOME STUDIES
		Statins
		Cholesterol Absorption Inhibitors
		Fibric Acid Derivatives
		Nicotinic Acid
		Bile Acid Sequestrants
		Omega-3 Polyunsaturated Fatty Acids
	MANAGEMENT OF DYSLIPIDEMIA IN CHRONIC KIDNEY DISEASE
		Screening, Monitoring, and Treatment Targets
		Clinical Practice Guidelines and Treatment Recommendations
		Practical Approach to Managing Dyslipidemia in Chronic Kidney Disease
	NOVEL LIPID-MODIFYING AGENTS
	SUMMARY AND CONCLUSIONS
	References and Suggested Readings
13 Glucose Control in Diabetes Mellitus and Kidney Disease
	SCREENING
		Screening for Diabetes in Asymptomatic Adults
		Screening Patients With Chronic Kidney Disease for Diabetes
		Screening Patients With Diabetes for Kidney Disease
		Screening for Eye Disease
		Screening for Peripheral Vascular Disease and Neuropathy
	GLYCEMIC CONTROL AND CHRONIC KIDNEY DISEASE
		Glycemic Goal of HbA1c <7.0%
		Benefits of Lowering HbA1c to Levels Above 7%
		Potential Risks of HbA1c Targets in the Range of 7%
		Lack of Cardiovascular Benefit of Lowering HbA1c Targets Below 7%
		Accuracy of HbA1c in Chronic Kidney Disease
		HbA1c and Home Glucose Monitoring and Targets
	MEDICAL THERAPY FOR DIABETES: INSULIN
		Long-Acting Insulins
		Intermediate-Acting Insulins: NPH
		Short-Acting (Regular) Insulin
		Rapid-Acting Insulins
		Premixed Combinations
		U100 Versus U200, U300, and U500 Dosages
		Prolongation of Insulin Action in Chronic Kidney Disease
	ORAL AGENTS AND NONINSULIN INJECTABLE DRUGS
		Sulfonylureas
		Glinides
		Biguanides (Metformin)
		Thiazolidinediones
		α-Glucosidase Inhibitors
		Dipeptidyl Peptidase Inhibitors
		Sodium Glucose Cotransporter 2 Inhibitors
		GLP-1 Receptor Agonists
		Pramlintide
	GLYCEMIC THERAPY FOR DIABETES: STRATEGY
		Type 1 Diabetes
		Glycemia Management of Type 2 Diabetes
	RISK OF HYPOGLYCEMIA
		Increased Risk of Hypoglycemia in Chronic Kidney Disease
	PANCREAS–KIDNEY TRANSPLANT
	IMPORTANCE OF REDUCING CARDIOVASCULAR AND METABOLIC RISK FACTORS
		Diabetic Dyslipidemias
		Blood Pressure Control
		Nutrition and Weight Control
	References and Suggested Readings
14 Optimizing Blood Pressure and Reducing Proteinuria
	HYPERTENSION AND PROGRESSION OF CHRONIC KIDNEY DISEASE
		Importance of Proteinuria on the Hypertension-Progression Relationship
	HYPERTENSION, CHRONIC KIDNEY DISEASE, AND CARDIOVASCULAR DISEASE RISK
		Blood Pressure Targets
	THE SPECTRUM OF ALBUMINURIA
		Effect of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers
		Aldosterone Receptor Antagonists
	MANAGEMENT OF HYPERTENSION
		Blood Pressure Measurement
		Low-Sodium Diet
		Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers
		Diuretics
	COMBINATION THERAPY
		RAAS Blocker Plus a Calcium Channel Blocker
		β-Blockers
		Calcium Channel Blockers
		Central α-Adrenergic Agonists
		Vasodilators
		α-Adrenergic Blockers
	RENOVASCULAR DISEASE
		Prevalence and Clinical Features
		Diagnostic Evaluation
		Medical Treatment
		Surgical Treatment or Stenting
	DOSAGE ADJUSTMENT OF ANTIHYPERTENSIVE DRUGS IN PATIENTS WITH REDUCED GLOMERULAR FILTRATION RATE
	References and Suggested Readings
15 Resistant Hypertension
	PREVALENCE, PATIENT CHARACTERISTICS, AND PROGNOSIS
	DIFFERENTIAL DIAGNOSIS
	SECONDARY HYPERTENSION
		Primary Aldosteronism
		Renal Parenchymal Disease
		Renovascular Disease
		Pheochromocytoma
		Obstructive Sleep Apnea
		Evaluation
		Blood Pressure Measurement
		Laboratory Tests
		Imaging Studies
	TREATMENT
		Use of Diuretics
		Combination Drug Therapy
		Aldosterone Antagonists
		Amiloride
		Potassium-Binding Agents
		Device-Based Therapies (e.g., Renal Denervation)
	Acknowledgments
	References and Suggested Readings
16 Peripheral Artery and Cerebrovascular Disease
	PERIPHERAL ARTERY DISEASE
		Prevention
		Peripheral Artery Disease Screening
		Diagnosis of Peripheral Artery Disease
		Medical/Noninvasive Therapies for Peripheral Artery Disease
		Invasive Therapies for Peripheral Artery Disease
	CEREBROVASCULAR DISEASE IN CHRONIC KIDNEY DISEASE: SCOPE OF THE PROBLEM
		Primary Prevention
		Secondary Prevention
		Diagnosis
		Treatment of Acute Stroke
		Nonmedical/Invasive Therapies for Secondary Prevention
	References and Suggested Readings
17 Diagnosis and Management of Acute Coronary Syndromes
	INTRODUCTION
	OVERVIEW OF ACUTE CORONARY SYNDROME
	PATHOPHYSIOLOGY
		Coronary Arteries in Chronic Kidney Disease
	CLINICAL PRESENTATION OF ACUTE CORONARY SYNDROME
		Evaluation
		History
		Physical Examination
		Electrocardiogram
		Cardiac Biomarkers
	ESTIMATION OF RISK
		Recent Medical History
		Examination Findings
		High-Risk Electrocardiogram Findings
		Prognostic Value of Cardiac Troponins
		Risk Prediction Algorithms
	BASIC PRINCIPLES OF MANAGEMENT
		Impact of Chronic Kidney Disease
	ANTI-ISCHEMIC AND ANALGESIC THERAPY
		Nitrates
		β-Adrenergic Receptor Blockers
		Calcium Channel Blockers
		Inhibitors of the Renin–Angiotensin–Aldosterone System
	ANTIPLATELET AND ANTICOAGULANT THERAPY
		Aspirin
		Thienopyridines: Clopidogrel, Prasugrel, and Ticagrelor
		Anticoagulation With Unfractionated Heparin or Low–Molecular-Weight Heparin
		Platelet Glycoprotein IIb/IIIa Inhibitors
	REPERFUSION THERAPY
	CORONARY REVASCULARIZATION
	SECONDARY PREVENTION
	CONCLUSION
	References and Suggested Readings
18 Heart Failure in Chronic Kidney Disease
	CARDIORENAL PHYSIOLOGY
		Left Ventricular Hypertrophy
		Diagnostic Guidelines for Heart Failure Based on Serum Markers
		Staging Guidelines for Heart Failure
		Treatment of Heart Failure in the Context of CKD
	ANTICOAGULATION FOR ATRIAL FIBRILLATION
	SLEEP APNEA AND HEART FAILURE
		Nitrates in the Setting of Heart Failure
	HYPERKALEMIA AND THE NEW POTASSIUM-LOWERING AGENT, PATIROMER
	SODIUM GLUCOSE COTRANSPORTER 2 INHIBITORS
	PRACTICAL SUGGESTIONS FOR DIURESIS FOR THE PATIENT WITH HEART FAILURE AND CKD
	NEPHROLOGY CARE FOR THE PATIENT WITH ADVANCED CKD
	References and Suggested Readings
19 Hematuria Investigation and Management
	SCREENING
	TESTING FOR HEMATURIA
		Dipstick Test
		Phase-Contrast Microscopy
	IS THE MICROSCOPIC HEMATURIA PERSISTENT?
	INVESTIGATING PERSISTENT MICROSCOPIC HEMATURIA
	INITIAL WORKUP
		Does the Presence of Microscopic Hematuria Predict End-Stage Renal Disease?
		Work-Up of Nonglomerular or Indeterminate Source of Bleeding
		Glomerular Bleeding
	References and Suggested Readings
20 Nephrotic Range Proteinuria
	CLINICAL PRESENTATION
	COMPLICATIONS OF NEPHROTIC RANGE PROTEINURIA
		Peripheral Edema
		Cardiovascular Complications
		Thromboembolic Events
		Protein Malnutrition
		Infections
		Acute Kidney Injury
		Disorders in Calcium Metabolism and Bone Lesions
	PROGNOSIS AND PREDICTIVE FACTORS
	INITIAL EVALUATION
		Quantification of Proteinuria
		Assessment of Complications
		Establishing an Underlying Cause
	SYMPTOMATIC TREATMENT OF NEPHROTIC RANGE PROTEINURIA
		Edema
		Proteinuria
		Hyperlipidemia
		Thromboembolic Complications
		Dietary Protein Intake
		Infection
		Acute Kidney Injury
		Disorders in Vitamin D and Calcium Metabolism
		Glucocorticoid-Induced Osteoporosis
	SPECIALIZED LABORATORY TESTS
		Urinary Biomarkers
		Selectivity Index
		Other Tests
	TREATMENT OF IDIOPATHIC GLOMERULAR DISEASES
		Membranous Nephropathy
		Focal Segmental Glomerulosclerosis
		Minimal Change Disease
		Immunoglobulin A Nephropathy
	TREATMENT OF SECONDARY GLOMERULAR DISEASES
		Obesity
		Lupus Nephritis
		Amyloidosis
	THE ELDERLY PATIENT WITH NEPHROTIC RANGE PROTEINURIA
	References and Suggested Readings
21 Acute Kidney Injury
	APPROACH TO DIFFERENTIAL DIAGNOSIS OF AKI
		Acute Tubular Necrosis
		Acute Interstitial Nephritis
		Hepatorenal Syndrome
		Abdominal Compartment Syndrome
		Urinary Tract Obstruction
	PROGNOSTIC INFORMATION
		Staging Criteria and Clinical Setting
		Oliguria
		Furosemide Challenge Test
	TIMING OF INITIATION OF RENAL REPLACEMENT THERAPY
	PREVENTION OF AKI AND AKI-RELATED COMPLICATIONS
		Cardiac Surgery
		Hemodynamic Optimization
		Intravascular Volume Optimization
		Decreasing Preoperative Kidney Injury Risk
		Limiting Postoperative Nephrotoxic Exposures
		Close Observation
		Iodinated Contrast Exposure (CT Scan or Angiography)
		Secondary Prevention
	NEPHROLOGY CONSULTATION
		Uncertain Etiology of AKI
		Suspected Glomerulonephritis
		Moderate to Severe AKI
		Preventive Measures
	PATIENT/FAMILY EDUCATION
		What Does Dialysis Do? Does Dialysis Help the Kidneys?
		Will the Patient Need to Be on Dialysis Permanently? What Is the Likelihood of Recovery?
		Is There Anything That Can Be Done to Promote Kidney Recovery?
		What Are the Risks of Dialysis? Does It Hurt?
		What Will Happen if the Patient Chooses Not to Pursue Dialysis? Or to Stop Dialysis at a Later Point?
	References and Suggested Readings
22 Anemia
	PATHOPHYSIOLOGY
		Erythropoietin
		Hypoxia-Inducible Factor
		Hepcidin and Ferroportin
		Iron
		Inflammation
	PREVALENCE OF ANEMIA IN CHRONIC KIDNEY DISEASE
	POTENTIAL BENEFITS OF CORRECTING ANEMIA
		Moderately Severe Anemia
		Correction of Mild Anemia
	APPROACH TO ANEMIA IN CHRONIC KIDNEY DISEASE
		Determining the Cause for Anemia
		Diagnosis of Iron Deficiency
	NONHEMATOLOGIC EFFECTS OF IRON
	REPLACING IRON
		Oral Iron
		Intravenous Iron Preparations
	ERYTHROPOIESIS-STIMULATING AGENT THERAPY
		Risks of Erythropoiesis-Stimulating Agent Therapy
		Target Hemoglobin Levels
		Erythropoiesis-Stimulating Agent Dosing Recommendations
		Causes of Erythropoiesis-Stimulating Agent Resistance
		Pure Red Cell Aplasia and Antierythropoietin Antibodies
	References and Suggested Readings
23 Drug Dosing in Chronic Kidney Disease
	INTRODUCTION
	ALTERED PHARMACOKINETIC PRINCIPLES IN RENAL FAILURE
		Bioavailability
		Volume of Distribution
		Protein Binding
		Biotransformation
		Pharmacogenomics
	DOSAGE ADJUSTMENT IN CHRONIC KIDNEY DISEASE
		Step 1: Obtain Past Medical History and Perform Physical Examination
		Step 2: Assess Renal Function
		Step 3: Determine Loading Dose
		Step 4: Determine Maintenance Dose
		Step 5: Monitor Drug Levels
		Drug Dosing Adjustment Tables
	References and Suggested Readings
24 Chronic Kidney Disease in Children
	DEMOGRAPHICS AND ETIOLOGY
	ASSOCIATED COMORBIDITIES
	ASSESSMENT OF KIDNEY FUNCTION IN CHILDREN
		Glomerular Filtration Rate
		Creatinine-Based Estimates of Glomerular Filtration Rate
		Cystatin-Based Estimates of Glomerular Filtration Rate
		Assessment of Proteinuria
	HYPERTENSION
		Prevalence, Etiology, and Mechanisms
		Definition of Hypertension in Childhood
		Measurement of Blood Pressure in Children
		End-Organ Damage From Childhood Hypertension
		Management of Hypertension in Children With Chronic Kidney Disease
	THE HEART IN PEDIATRIC CHRONIC KIDNEY DISEASE
	PROGRESSION OF CHRONIC KIDNEY DISEASE IN CHILDREN
	RENAL OSTEODYSTROPHY
		Consequences of Altered Bone and Mineral Metabolism in Children
		Markers of Bone and Mineral Metabolism in Children
		Therapeutic Options
	GROWTH, NUTRITION, AND DEVELOPMENT IN CHILDREN WITH CHRONIC KIDNEY DISEASE
		Patterns of Uremic Growth Failure
		Etiology of Growth Failure and Developmental Delay in Chronic Kidney Disease
		Treatment of Uremic Growth Failure
	WHEN SHOULD DIALYSIS BE INITIATED IN CHILDREN AND ADOLESCENTS WITH CHRONIC KIDNEY DISEASE?
	References and Suggested Readings
25 Pregnancy in Chronic Kidney Disease
	RENAL CHANGES IN PREGNANCY
	FERTILITY
	ESTIMATION OF GLOMERULAR FILTRATION RATE IN PREGNANCY
	HYPERTENSION AND PREECLAMPSIA
		Hypertension
	PROTEINURIA IN PREGNANCY
	URINARY TRACT INFECTIONS
		Hyperlipidemia
		Venous Thrombosis
	PROBLEMS SPECIFIC TO CHRONIC KIDNEY DISEASE PATIENTS
		Rapid Decline in Renal Function
		Anemia
		Bone Disease
		Low-Protein Diet
	LUPUS NEPHRITIS IN PREGNANCY
	CKD DIAGNOSED DURING PREGNANCY
	References and Suggested Readings
26 Management of Chronic Kidney Disease in Older Adults
	HOW DOES GLOMERULAR FILTRATION RATE CHANGE WITH AGE?
	WHAT IS THE PREVALENCE OF A LOW-ESTIMATED GLOMERULAR FILTRATION RATE IN OLDER ADULTS?
	WHAT IS THE CLINICAL SIGNIFICANCE OF A LOW-ESTIMATED GLOMERULAR FILTRATION RATE IN OLDER ADULTS?
	HOW DOES URINARY ALBUMIN EXCRETION CHANGE WITH AGE?
	WHAT IS THE PROGNOSTIC VALUE OF ALBUMINURIA IN OLDER ADULTS?
	TO WHAT EXTENT IS CHRONIC KIDNEY DISEASE ASSOCIATED WITH OTHER COMORBID CONDITIONS IN OLDER ADULTS?
	SHOULD OLDER ADULTS BE SCREENED FOR CHRONIC KIDNEY DISEASE?
	HOW SHOULD RENAL FUNCTION BE MEASURED IN OLDER ADULTS?
	WHAT IS AN APPROPRIATE TARGET BLOOD PRESSURE IN OLDER PATIENTS WITH CHRONIC KIDNEY DISEASE?
	WHAT AGENTS SHOULD BE PRESCRIBED TO SLOW PROGRESSION OF CHRONIC KIDNEY DISEASE IN OLDER ADULTS?
	ARE THERE ADVERSE ASPECTS TO PROTEIN AND/OR CALORIE RESTRICTION IN OLDER ADULTS?
	WHICH OLDER PATIENTS WITH CHRONIC KIDNEY DISEASE SHOULD BE REFERRED TO A NEPHROLOGIST?
	WHAT PREPARATION IS NEEDED FOR HEMODIALYSIS?
	WHAT ARE KEY CONSIDERATIONS IN FACILITATING INFORMED DECISION MAKING AMONG OLDER ADULTS WITH ADVANCED CHRONIC KIDNEY DISEASE?
	References and Suggested Readings
27 Chronic Kidney Disease in Asia
	ADJUSTMENT OF EQUATIONS FOR ESTIMATING GLOMERULAR FILTRATION RATES IN ASIANS
	LOWER GLOMERULAR FILTRATION RATE/1.73 M2 IN ASIANS
	ETIOLOGY OF KIDNEY DISEASE IN ASIAN COUNTRIES
		Hypertension
		Insulin Resistance and Obesity
		Diabetes
		Nephritis and Toxins
		Awareness of CKD and Education
	INCREASED RISK OF PROGRESSION
	INCREASED RATE OF SURVIVAL OF THOSE WITH CHRONIC KIDNEY DISEASE
	DIETARY ASPECTS AND MEDICATION USE IN ASIA
		Toxic Herbs
		Toxic Foods and Food Supplements
		Djenkol Bean or Jering
		Star Fruit
	References and Suggested Readings
28 Preemptive Kidney Transplantation
	WHAT RENAL REPLACEMENT OPTIONS ARE AVAILABLE TO PATIENTS WITH CHRONIC KIDNEY DISEASE?
	WHY IS TRANSPLANTATION A BETTER CHOICE THAN DIALYSIS FOR ESRD PATIENTS?
	WHAT IS “PREEMPTIVE” TRANSPLANTATION?
	IS PREEMPTIVE TRANSPLANTATION BETTER THAN GETTING A TRANSPLANT AFTER THE INITIATION OF DIALYSIS?
		Cost
	HOW SOON CAN A PATIENT BE LISTED FOR PREEMPTIVE TRANSPLANTATION?
	HOW MANY PATIENTS ACTUALLY RECEIVE A PREEMPTIVE RENAL TRANSPLANT?
	DOES THE NEW UNOS CADAVERIC ALLOCATION SYSTEM FAVOR PREEMPTIVE RENAL TRANSPLANTATION?
	DOES PREEMPTIVE TRANSPLANTATION ALSO BENEFIT PATIENTS RECEIVING A COMBINED KIDNEY–PANCREAS TRANSPLANT?
	CAN PREEMPTIVE TRANSPLANTATION BE DONE FOR A SECOND KIDNEY TRANSPLANT?
	WHAT ABOUT THE USE OF HEPATITIS C+ OR HIV+ PATIENTS TO EXPAND THE DONOR POOL?
	WHAT TOOLS CAN BE USED TO HELP INCREASE THE RATES OF PREEMPTIVE TRANSPLANTATION?
	WHAT IS TRANSPLANT TOURISM AND HOW DOES IT AFFECT PREEMPTIVE TRANSPLANTATION?
	CONCLUSIONS
	References and Suggested Readings
29 Preparing for Dialysis
	OBJECTIVES IN LATER STAGES OF CHRONIC KIDNEY DISEASE
	WHAT THE PATIENT CAN EXPECT FROM DIALYSIS
	OBJECTIVES FOR PATIENT EDUCATION
	CHOICES
	THE DIALYSIS ACCESS: NEED FOR TIMELY PREPARATION
		Avoiding Damage to Arm Veins
		Futility Versus Incomplete Preparation
	END-OF-LIFE CARE WITHOUT DIALYSIS
		Palliative Care Tool Kit From the Renal Physicians Association
	AVOIDING NEPHROTOXIC CONTRAST AGENTS
	THE USE OF ANGIOTENSIN-CONVERTING ENZYME INHIBITORS OR ANGIOTENSIN RECEPTOR BLOCKERS
		Fluid Management
		Hyperkalemia
		Metabolic Acidosis
		Uremic Pericarditis, Bleeding, and Neuropathy/Encephalopathy
	EARLIER VERSUS LATER START OF DIALYSIS
		Deciding to Start Dialysis
		Incremental Start
		Delaying Dialysis in the Elderly by Conservative Management Including a Very–Low-Protein Diet
	References and Suggested Readings
30 Tool Kits and Web-Based Resources
	INTRODUCTION
	CHRONIC KIDNEY DISEASE TOOL KITS
		Renal Physicians Association’s Advanced Chronic Kidney Disease Patient Management Tool Kit
		The U.S. National Kidney Foundation’s CKDinform Toolbox
		Kidney Health Australia Handbook
		The Michigan Quality Improvement Consortium Set of Clinical Action Plans
		The British Columbia Guidelines and Protocols Advisory Committee
		Henry Ford Healthcare System Booklet
		Updates to Tool Kits and Web Resources
	EDUCATIONAL RESOURCES FOR THE NEPHROLOGY PROVIDER
		UKidney
		NephJC
		American Society of Nephrology Communities
	GENERAL PATIENT INFORMATION SITES REGARDING CARDIOVASCULAR DISEASE, DIABETES, AND HYPERTENSION
		Heart Hub for Patients
		American Diabetes Association
		National Institutes of Health-Related Resources
	OTHER INFORMATIVE WEB SITES
		National Institutes of Health Related
		National Kidney Foundation
		American Association of Kidney Patients
		Medical Education Institute (homedialysis.org)
		International Society for Hemodialysis
		Sites for High-Information Patients
		Miscellaneous Physician and Nurse-Focused Internet Sites
	References and Suggested Readings
31 International Guidelines for Chronic Kidney Disease, Cardiovascular Disease, and Diabetes
	MAIN ORGANIZATIONS DEVELOPING GUIDELINES ON DETECTING AND MANAGING CHRONIC KIDNEY DISEASE
		Canadian Society of Nephrology (CSN)
		European Renal Best Practice (ERBP)
		Kidney Health Australia—Caring for Australasians With Renal Impairment (KHA-CARI)
		Kidney Disease Improving Global Outcomes
		National Institute for Health and Care Excellence
		National Kidney Foundation—Kidney Disease Outcomes Quality Initiative
		Scottish Intercollegiate Guidelines Network
		U.K. Renal Association
	CARDIOVASCULAR, HYPERTENSION, AND DIABETES GUIDELINES ADDRESSING ISSUES RELATING TO CHRONIC KIDNEY DISEASE
		Cardiovascular Disease
		Hypertension
		Diabetes
	References and Suggested Readings
Appendix 1: More Equations for Estimating Glomerular Filtration Rate and Expected Daily Creatinine Excretion Rate
	CHRONIC KIDNEY DISEASE EPIDEMIOLOGY COLLABORATION (CKD-EPI) EQUATION SET FOR CALCULATING ESTIMATED GLOMERULAR FILTRATION RATE (EGFR)
		African-American Woman
		African-American Man
		White (or Other Race) Woman
		White (or Other Race) Man
	EXPECTED 24-HOUR CREATININE EXCRETION RATES
	SALAZAR–CORCORAN EQUATION
	References and Suggested Readings
Appendix 2: Ideal, Lean, Median Standard, and Adjusted Body Weights
	IDEAL BODY WEIGHT EQUATIONS (KG)
		Method of Devine (1974)
		Method of Robinson (1983)
	ADJUSTED BODY WEIGHT (KG)
	LEAN BODY WEIGHT EQUATIONS (KG)
	References and Suggested Readings
Index