Management of Chronic Kidney Disease: A Clinician’s Guide

Preface
Contents
1: What Is Chronic Kidney Disease?
	1.1	 Introduction
	1.2	 Definition of CKD
	1.3	 Staging of CKD
	1.4	 Epidemiology of CKD
	1.5	 Etiology of CKD
	1.6	 Progression of CKD
	1.7	 Genetics of CKD
	1.8	 Detection
	References
2: Clinical Assessment of a Patient with Chronic Kidney Disease
	2.1	 History and Physical Examination of a Chronic Kidney Disease Patient
	2.2	 Estimating or Measuring Glomerular Filtration Rate in CKD
	2.3	 Urinalysis and Albuminuria in CKD
	2.4	 Other Lab Tests in CKD
	References
3: Imaging in Chronic Kidney Disease
	3.1	 Diagnostic Imaging in CKD
	3.2	 Radiological Investigations
		3.2.1	 Conventional Radiography
		3.2.2	 Ultrasound
		3.2.3	 CT Imaging
		3.2.4	 MR Imaging
		3.2.5	 Angiography
	3.3	 Nuclear Scanning
	3.4	 Contrast Medium-Induced Nephropathy in CKD
	3.5	 Nephrogenic Systemic Fibrosis
	Further Reading
4: Diabetic Kidney Disease: Increasing Hope with Transformative Therapies
	4.1	 Epidemiology
	4.2	 Diagnosis
	4.3	 Pathophysiology
	4.4	 Disease Progression
	4.5	 Prevention and Treatment
		4.5.1	 Glycemia
		4.5.2	 Sodium-Glucose Co-transporter 2 Inhibitor (SGLT2i)
		4.5.3	 Glucagon-Like Peptide 1 Receptor Agonists (GLP1RA)
		4.5.4	 Blood Pressure Control
		4.5.5	 RAS Blockade
		4.5.6	 Nonsteroidal Mineralocorticoid Receptor Antagonist (nsMRA)
		4.5.7	 Weight Management
		4.5.8	 Protein Restriction
	4.6	 Conclusion
	References
5: Hypertension and Chronic Kidney Disease
	5.1	 BP Measurement
		5.1.1	 Office-Based BP Measurements
		5.1.2	 Out-of-Office BP Monitoring
	5.2	 BP Management in Patients with CKD, With or Without Diabetes, Not Receiving Dialysis
		5.2.1	 BP Targets
		5.2.2	 Treatment with Antihypertensive Drugs, Including RAS-Inhibitors
	References
6: Dyslipidaemia in Kidney Disease
	6.1	 Lipids and Cardiovascular Disease
	6.2	 Lipid-Lowering Therapy
		6.2.1	 Low Density Lipoprotein-Lowering Therapy
			6.2.1.1	 Statins
			6.2.1.2	 Ezetimibe
			6.2.1.3	 Bile Acid Sequestrants
			6.2.1.4	 Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors
		6.2.2	 Triglyceride-Lowering Therapy
			6.2.2.1	 Fibrates
			6.2.2.2	 Omega-3 Fatty Acids
		6.2.3	 Lipoprotein(a)
			6.2.3.1	 Inhibitors of Lipoprotein(a) Synthesis
	6.3	 Management of Lipids in Patients with CKD and ESKD
		6.3.1	 Guidelines
		6.3.2	 Assessment of Lipid Status at Baseline
		6.3.3	 Assessment of Lipid Status After Starting Treatment
		6.3.4	 Lipid-Lowering Treatment
	References
Untitled
7: Hyperuricaemia and Chronic Kidney Disease
	7.1	 Introduction
		7.1.1	 Normal Urate Metabolism
		7.1.2	 Pathophysiology of Urate
	7.2	 Population Level Evidence Linking Serum Urate Levels to Disease in Humans
	7.3	 Urate-Lowering Therapy to Modify CKD
	7.4	 Cardiovascular Risk, CKD, and Urate-Lowering Therapy
	7.5	 Urate-Lowering Therapy in Gout and CKD
	7.6	 Conclusions
	References
8: Acute Kidney Injury in Chronic Kidney Disease
	8.1	 Introduction: The Growing Impact of AKI
		8.1.1	 Occurrence and Definition
		8.1.2	 Prognosis
	8.2	 CKD as a Risk Factor for AKI
	8.3	 AKI as a Risk Factor for CKD
	8.4	 Prevention and Management of AKI in CKD
		8.4.1	 Before and Early During Hospitalization: Recognizing High-Risk Patients and Situations
		8.4.2	 Determining the Time Course and Diagnosis of AKI
		8.4.3	 History, Physical Exam, and the Differential Diagnosis of AKI
		8.4.4	 General Management Principles
		8.4.5	 Renal Replacement Therapy (RRT)
		8.4.6	 Special Considerations for the Hospitalized Patient with AKI or CKD
		8.4.7	 Following AKI: At the Time of Discharge and Beyond
		8.4.8	 Novel Biomarkers in the Diagnosis of AKI
	8.5	 Conclusion
	References
9: Preventing Progression of Chronic Kidney Disease: Diet and Lifestyle
	9.1	 Diet and Lifestyle in the Management of Chronic Kidney Disease
	9.2	 Should Patients with CKD Restrict Their Intake of Protein?
	9.3	 Should Patients with CKD Become Vegetarian or Vegan?
	9.4	 Should Patients with CKD Restrict Their Intake of Calcium and Phosphorus?
	9.5	 Should Patients with CKD Restrict Their Intake of Potassium?
	9.6	 Should Obese Patients with CKD Lose Weight?
	9.7	 Should All Patients with CKD Be on a Low-Fat Diet?
	9.8	 Should Patients with CKD Restrict Their Intake of Salt?
	9.9	 Should Patients with CKD Be Undertaking Regular Physical Activity?
	9.10	 Should Patients with CKD Give Up Drinking Alcohol?
	9.11	 All Smokers with CKD Should Be Encouraged to Stop Smoking
	9.12	 Does Diet and Lifestyle Really Matter in Patients with CKD?
	References
10: Preventing Progression of  Chronic Kidney Disease: Renin–Angiotensin–Aldosterone System Blockade Beyond Blood Pressure
	10.1	 The Renin–Angiotensin–Aldosterone System (RAAS)
	10.2	 How Do You Block the RAAS?
	10.3	 What Is the Evidence That RAAS Blockade Protects the Kidneys in CKD?
	10.4	 Does RAAS Blockade Only Protect the Kidneys by Improving Blood Pressure Control?
	10.5	 Does RAAS Blockade Only Protect the Kidneys by Reducing Proteinuria?
	10.6	 Does RAAS Blockade Have Independent Hemodynamic Effects on the Kidney to Slow Progressive Functional Decline?
	10.7	 Does RAAS Blockade Have Direct Effects on Pathogenic Pathways to Slow Progressive Functional Decline?
	10.8	 Does RAAS Blockade Protect the Kidneys by Improving Adherence?
	10.9	 Is the Effect of RAAS Blockade on the Kidneys Sustained?
	10.10	 What Is the Best Dose to Use to Protect the Kidneys in CKD?
	10.11	 What Are the Potential Drawbacks of RAAS Blockade?
	10.12	 Is There Any Advantage for Combined RAAS Blockade?
		10.12.1 Combined ACE Inhibition and Angiotensin Receptor Blockade
		10.12.2 Mineralocorticoid Receptor Blockade
	10.13	 Shouldn’t Everyone with CKD Receive a RAAS Inhibitor If Tolerated?
	10.14	 Should I Keep Using a RAAS Inhibitor in Advanced CKD If Tolerated?
	References
11: Chronic Kidney Disease and the Cardiovascular Connection
	11.1	 Introduction
	11.2	 Why Does Chronic Kidney Disease Convey Increased Cardiovascular Risk?
	11.3	 Does Kidney Disease Promote Coronary Atherosclerosis Calcification?
	11.4	 Why Does the Heart Fail as a Pump in Kidney Patients?
	11.5	 Should I Hear a Murmur?
	11.6	 Why Are There More Arrhythmias?
	11.7	 Summary
	References
12: Screening and Diagnosing Cardiovascular Disease in Chronic Kidney Disease
	12.1	 Why Screening for Cardiovascular Disease Is Important in Chronic Kidney Disease
	12.2	 What Are the Approaches to Screen for Coronary Artery Disease?
	12.3	 Should Patients with Chronic Kidney Disease Undergo Routine Echocardiography?
	12.4	 What Blood Biomarkers Are Useful in Heart Failure?
	12.5	 Should Patients with Renal Dysfunction Have Arrhythmia Surveillance?
	12.6	 Summary
	References
13: Management of Cardiovascular Disease in Chronic Kidney Disease
	13.1	 Coronary Atherosclerosis
		13.1.1	 Dyslipidemia Management: Should Patients with Kidney Disease Receive Statins?
		13.1.2	 Antiplatelet Therapy: Which Agents for What Syndromes?
		13.1.3	 Angina Relief
			13.1.3.1	 Nitrates
			13.1.3.2	 Beta-Blockers
			13.1.3.3	 Calcium Channel Blockers
			13.1.3.4	 Ranolazine
		13.1.4	 Management of Acute Coronary Syndrome
		13.1.5	 Revascularization Therapy
			13.1.5.1	 Percutanous Coronary Intervention
			13.1.5.2	 Coronary Artery Bypass Greft
	13.2	 Heart Failure
		13.2.1	 Prognosis of HF Patients with CKD
			13.2.1.1	 Principles of Management of HF Patients with CKD
			13.2.1.2	 Challenges in the Management of HF Patients with CKD
				Diuretic Resistance
		13.2.2	 Lifestyle Changes for Management of HF Patients with CKD
			13.2.2.1	 Drug Therapy for HF with Reduced EF and CKD
				ACEI or ARB
				SGLT2 Inhibitors
					Initial Increase in Serum Creatinine with Initiation of ACEi/ARB and SGLT2 Inhibitor Therapy
				B-Blockers
				Mineralocorticoid Receptor Antagonists
				Diuretics
				Angiotensin Receptor Neprilysin Inhibitor
				Ivabradin
				Digitalis
			13.2.2.2	 Ultrafiltration
	13.3	 Arrhythmias
	13.4	 Valvular and Pericardial Heart Disease
	References
14: Cerebrovascular Disease and Chronic Kidney Disease
	14.1	 Introduction
	14.2	 Epidemiology
	14.3	 Pathophysiology and Risk Factors
	14.4	 Investigations
	14.5	 Acute Management
	14.6	 Preventative Therapies
		14.6.1	 Lifestyle Modifications
		14.6.2	 Antiplatelet Therapies
		14.6.3	 Anticoagulation
		14.6.4	 Dual Blockade
		14.6.5	 Lipid-Lowering Therapy
		14.6.6	 Antihypertensive Therapy
		14.6.7	 Carotid Interventions
		14.6.8	 SGLT-2 Inhibitors
	References
15: Anemia and Disorders of Hemostasis in Chronic Kidney Disease
	15.1	 Definition of Anemia
	15.2	 Prevalence of Anemia in Chronic Kidney Disease
	15.3	 Importance of Anemia in Chronic Kidney Disease
	15.4	 Etiology and Pathophysiology of Anemia in Chronic Kidney Disease
	15.5	 Evaluation of Anemia in Chronic Kidney Disease
	15.6	 Treatment of Anemia in Chronic Kidney Disease
	15.7	 Target Hemoglobin Levels
	15.8	 Iron Treatment
		15.8.1	 Sodium Ferric Gluconate and Iron Sucrose
		15.8.2	 Ferumoxytol
		15.8.3	 Ferric Carboxymaltose
		15.8.4	 Ferric Derisomaltose
		15.8.5	 Ferric Pyrophosphate Citrate
	15.9	 Erythropoietin Treatment
	15.10	 HIF-PHI Inhibitors
	15.11	 Other Drugs for Anemia
	15.12	 Red Blood Cell Transfusion
	15.13	 Normal Hemostasis
	15.14	 Increased Risk of Bleeding in Chronic Kidney Disease
	15.15	 Increased Risk of Thrombosis in Chronic Kidney Disease
	References
16: Mineral and Bone Disorders in Chronic Kidney Disease
	16.1	 Mineral and Bone Disorders in CKD
		16.1.1	 General Aspects, Epidemiology, and Pathophysiology
	16.2	 Diagnosis of CKD–MBD
		16.2.1	 Biochemical Abnormalities
		16.2.2	 Bone Abnormalities
		16.2.3	 Diagnosis and Type of Vascular Calcification
		16.2.4	 Epidemiology and Pathophysiology of Vascular Calcification
		16.2.5	 Vascular Calcification and Bone Health
		16.2.6	 Calciphylaxis
	16.3	 Management of CKD–MBD
		16.3.1	 Management of Biochemical Abnormalities
		16.3.2	 Osteoporosis
		16.3.3	 Vascular Calcification
		16.3.4	 Calciphylaxis
	References
17: Protein–Energy Wasting and Nutritional Interventions in Chronic Kidney Disease
	17.1	 Protein and Energy Wasting in CKD: Definition, Epidemiology, and Clinical Relevance
	17.2	 Screening and Assessment of Nutritional Status in CKD
	17.3	 Etiology of Protein–Energy Wasting
	17.4	 Prevention of PEW: A Cause-Specific Approach
		17.4.1	 Dietary Nutrient Intake in CKD Patients
		17.4.2	 Dietary Protein Restriction in CKD and the Use of Ketoacids
		17.4.3	 Renal Replacement Therapy as a Catabolic Stimulus
		17.4.4	 Systemic Inflammation
		17.4.5	 Comorbidities in CKD
		17.4.6	 Metabolic Acidosis
	17.5	 Treatment of Protein–Energy Wasting
		17.5.1	 Oral and Enteral Nutritional Supplementation
		17.5.2	 Intradialytic Parenteral Nutrition (IDPN)
		17.5.3	 Adjunctive Therapies
			17.5.3.1	 Exercise
			17.5.3.2	 Anabolic Hormones
			17.5.3.3	 Other Therapies for Treatment of PEW in CKD
			17.5.3.4	 Obesity in CKD
	References
18: Metabolic Acidosis and Chronic Kidney Disease
	18.1	 Introduction
	18.2	 Pathophysiology
	18.3	 Clinical and Laboratory Characteristics
	18.4	 Assessment of Acid-Base Balance in CKD
	18.5	 Adverse Effects of the Chronic Metabolic Acidosis of CKD and Rationale for Treatment
	18.6	 Treatment
	18.7	 Conclusions and Future Directions
	References
19: Infectious Complications and Vaccination in Chronic Kidney Disease
	19.1	 Infections and Chronic Kidney Disease
	19.2	 Epidemiology of Infections in CKD
		19.2.1	 Urinary Tract Infections
		19.2.2	 Pneumonia
		19.2.3	 COVID-19
		19.2.4	 HIV Infection
		19.2.5	 Vascular Access-Related Infections
		19.2.6	 Blood-Borne Infections
		19.2.7	 Tuberculosis
		19.2.8	 Other Infections
	19.3	 Infection Control in CKD
		19.3.1	 Vaccination in Patients with CKD
	19.4	 Conclusion
	References
20: Endocrine Disorders in Chronic Kidney Disease
	20.1	 Introduction
	20.2	 Abnormalities in the Erythropoietin Secretion
	20.3	 Abnormalities in the Vitamin D Metabolites
	20.4	 Abnormalities in the Hormones of the Hypothalamic–Pituitary–Gonadal Axis in Men with CKD
		20.4.1	 Luteinizing Hormone
		20.4.2	 Follicle-Stimulating Hormone
		20.4.3	 Prolactin
		20.4.4	 Testicular Hormones
	20.5	 Abnormalities in the Hormones of the Hypothalamic–Pituitary–Gonadal Axis in Women with CKD
		20.5.1	 Luteinizing Hormone
		20.5.2	 Follicle-Stimulating Hormone
		20.5.3	 Prolactin
		20.5.4	 Estrogens
		20.5.5	 Anti-Müllerian Hormone
	20.6	 Abnormalities in the Growth Hormone/Insulin-Like Growth Factor (Somatotropic) Axis
		20.6.1	 Growth Hormone
		20.6.2	 Insulin-Like Growth Factors
		20.6.3	 Growth Hormone Therapy
	20.7	 Abnormalities in the Adrenocorticotropin–Cortisol Axis
	20.8	 Abnormalities in Arginine Vasopressin
	20.9	 Abnormalities in the Thyroid Gland and Hypothalamic–Pituitary–Thyroid Axis
		20.9.1	 Thyroid Hormones
		20.9.2	 The Thyroid-Stimulating Hormone
		20.9.3	 Primary Hypothyroidism and Hyperthyroidism
	20.10	 Aldosterone
	20.11	 Abnormalities in Insulin and Glucagon
		20.11.1 Insulin Secretion and Clearance
		20.11.2 Insulin Resistance
		20.11.3 Clinical Consequences of Hyperglycemia and Insulin Resistance
	20.12	 Abnormalities in the Cardiac Natriuretic Peptides
	20.13	 Abnormalities in Cardiotonic Steroids
	20.14	 Abnormalities in Gastrointestinal Hormones
	20.15	 Abnormalities in the Hormones of Adipose Tissue
	References
21: Liver and Gastrointestinal Tract Problems in Chronic Kidney Disease
	21.1	 Liver and Gastrointestinal Tract Disease as Potential Clues to CKD Etiology
		21.1.1	 Liver and Kidney Disease from a Systemic Disease
			21.1.1.1	 Autosomal-Dominant Polycystic Kidney Disease
			21.1.1.2	 Paraproteins in Liver and Kidney Disease
		21.1.2	 Liver Disease as Cause of Kidney Disease
			21.1.2.1	 Hepatorenal Syndrome: Acute Kidney Injury
			21.1.2.2	 Infectious Liver Diseases as a Cause of Kidney Disease
		21.1.3	 Gastrointestinal Tract Disease
			21.1.3.1	 Kidney and GI Tract Disease from a Systemic Disease
				IgA Vasculitis
				Atheroembolic Disease
		21.1.4	 Diseases of the GI Tract or Pancreas as a Cause of CKD
			21.1.4.1	 Oxalate Nephropathy
			21.1.4.2	 Phosphate Nephropathy
		21.1.5	 Concomitant Liver and GI Tract Disease and CKD
			21.1.5.1	 HCV as a Cause of Liver Disease in CKD
			21.1.5.2	 HBV as a Cause of Liver Disease in CKD
			21.1.5.3	 Other Causes of Liver Disease in Chronic Kidney Disease
	21.2	 Gastrointestinal Tract
		21.2.1	 Upper Gastrointestinal Tract
			21.2.1.1	 Upper GI Tract Symptoms
				Upper GI Tract Disease More Prevalent in CKD Patients
		21.2.2	 Lower Gastrointestinal Tract
			21.2.2.1	 Bowel Movement Disturbances
				Lower GI Tract Disease More Prevalent in CKD Patients
	21.3	 Conclusion
	References
22: Fluid and Electrolyte Problems in Chronic Kidney Disease
	22.1	 Introduction
	22.2	 Volume or Sodium Balance Disorders
		22.2.1	 Role of the Kidney in Sodium Balance Regulation
		22.2.2	 Volume Overload in CKD
			22.2.2.1	 Clinical Diagnosis of Volume Overload
			22.2.2.2	 Treatment of Volume Overload
		22.2.3	 Volume Depletion in CKD
			22.2.3.1	 Clinical Diagnosis of Volume Depletion
			22.2.3.2	 Treatment of Volume Depletion
	22.3	 Water Balance Disorders
		22.3.1	 Role of the Kidney in Water Balance Regulation
		22.3.2	 Hyponatremia in CKD
			22.3.2.1	 Differential Diagnosis of Hyponatremia
			22.3.2.2	 Treatment of Hyponatremia
		22.3.3	 Hypernatremia in CKD
	22.4	 Potassium Balance Disorders
		22.4.1	 Role of the Kidney in Potassium Balance Regulation
		22.4.2	 Hyperkalemia in CKD
			22.4.2.1	 Differential Diagnosis of Hyperkalemia
			22.4.2.2	 Treatment of Hyperkalemia
		22.4.3	 Hypokalemia in CKD
			22.4.3.1	 Differential Diagnosis of Hypokalemia
			22.4.3.2	 Treatment of Hypokalemia
	References
23: Pruritus and Other Dermatological Problems in Chronic Kidney Disease
	23.1	 Pruritus
		23.1.1 What Causes Pruritus in Chronic Kidney Disease?
		23.1.2 What Are the Important Clinical Characteristics?
		23.1.3 How Is Pruritus in CKD Treated?
	23.2	 Xerosis
		23.2.1 What Causes Xerosis in CKD?
		23.2.2 What Are the Important Clinical Characteristics?
		23.2.3 How Is Xerosis in CKD Treated?
	23.3	 Lindsay’s (Half-and-Half) Nails
		23.3.1 What Causes Lindsay’s Nails in CKD?
		23.3.2 How Do you Treat Lindsay’s Nails?
	23.4	 Acquired Perforating Dermatosis
		23.4.1 What Causes Acquired Perforating Dermatosis?
		23.4.2 What Are Important Clinical Considerations of Acquired Perforating Dermatosis?
		23.4.3 How Do you Treat Acquired Perforating Dermatosis?
	23.5	 Calciphylaxis
		23.5.1 What Causes Calciphylaxis?
		23.5.2 What Are Important Clinical Considerations of Calciphylaxis?
		23.5.3 What Are the Treatments of Calciphylaxis?
	23.6	 Metastatic Calcinosis Cutis
		23.6.1 What Causes Metastatic Calcinosis Cutis?
		23.6.2 What Are the Important Clinical Considerations?
		23.6.3 What Is the Treatment for Calcinosis Cutis?
	23.7	 Nephrogenic Systemic Fibrosis
		23.7.1 What Causes NSF?
		23.7.2 What Are the Important Clinical Considerations in NSF?
		23.7.3 What Is the Treatment of NSF?
	23.8	 Pseudoporphyria
		23.8.1 What Causes Pseudoporphyria?
		23.8.2 What Are the Important Clinical Considerations in Pseudoporphyria?
		23.8.3 What Is the Treatment for Pseudoporphyria?
	23.9	 Porphyria Cutanea Tarda
		23.9.1 What Causes PCT?
		23.9.2 What Are some Clinical Considerations?
		23.9.3 How Do you Treat PCT?
	References
24: Pain Management in Chronic Kidney Disease
	24.1	 Pain in CKD
		24.1.1	 Causes of Pain
		24.1.2	 Types of Pain
	24.2	 Screening and Assessment of Pain (Box 24.1)
		24.2.1	 Obtaining a Pain History
	24.3	 Management of Pain
		24.3.1	 Barriers to Pain Management
		24.3.2	 Non-pharmacological Management
		24.3.3	 Drug Management
		24.3.4	 Neuropathic (Nerve) Pain
		24.3.5	 Other
	24.4	 Conclusion
	References
25: Depression and Other Psychological Issues in CKD
	25.1	 Prevalence of Depression in Patients with CKD
	25.2	 Association of Depression with Adverse Clinical Outcomes
	25.3	 Risk Factors for Depression in Patients with CKD
	25.4	 Potential Mechanisms for the Association of Depression with Adverse Outcomes
	25.5	 How to Identify Depression in Patients with CKD
	25.6	 Differential Diagnosis of Depression in Patients with CKD
	25.7	 Treatment of Depression in Patients with CKD
	25.8	 Recommendations and Conclusions
	References
26: Sexual Dysfunction in Chronic Kidney Disease
	26.1	 Introduction
	26.2	 Male Sexual Dysfunction
	26.3	 Female Sexual Dysfunction
	26.4	 Diagnosis and Evaluation of Sexual Dysfunction
		26.4.1	 In Men
		26.4.2	 In Women
	26.5	 Management of Sexual Dysfunction in Men and Women
		26.5.1	 In Men
		26.5.2	 In Women
	References
27: Sleep Disorders in Chronic Kidney Disease
	27.1	 Introduction
	27.2	 Sleep Disorders and their Effects in CKD
	27.3	 Sleep Disorders in CKD Not Needing Dialysis
	27.4	 Restless Leg Syndrome and Periodic Limb Movements of Sleep
	27.5	 Sleep Apnea
	27.6	 Sleep Apnea Syndrome as a Trigger of CKD
	27.7	 Excessive Daytime Sleepiness
	27.8	 Alexithymia and Sleep Disorders in CKD
	27.9	 Putative Determinants of Sleep Disorders in CKD
	27.10	 Mild Cognitive Impairment and Sleep Disorders in CKD
		27.10.1 Mild Cognitive Impairment
		27.10.2 Cognitive Dysfunction and Sleep Disorders in CKD
	27.11	 Impairment of the Melatonin Clock in CKD
	27.12	 Management of Sleep Disorders in CKD
		27.12.1 Insomnia
		27.12.2 Restless Leg Syndrome
		27.12.3 Sleep Apnea
	27.13	 Assessing Effectiveness of Interventions
	References
28: Neuropathy and Other Neurological Problems in Chronic Kidney Disease
	28.1	 Neuropathy in CKD
		28.1.1	 Peripheral Neuropathy
		28.1.2	 Autonomic Neuropathy
	28.2	 Carpal Tunnel Syndrome
	28.3	 Myopathy
	28.4	 Cognitive Disorders and Dementia
	28.5	 Encephalopathy and Delirium
	References
29: Drug Prescription in Chronic Kidney Disease
	29.1	 Difficulties Related to Drug Prescription in CKD
		29.1.1	 Multimorbidity in CKD
		29.1.2	 Polypharmacy and CKD
		29.1.3	 Screening, Monitoring, and Managing CKD
	29.2	 Changes in Pharmacokinetics of Drugs in CKD
		29.2.1	 Effects of Kidney Diseases on the Absorption Process
		29.2.2	 Effects of Kidney Diseases on the Distribution Process
		29.2.3	 Effects of Kidney Diseases on the Drug Metabolism Process
		29.2.4	 Effects of Kidney Diseases on the Excretion Process
	29.3	 Changes in Pharmacodynamics of Drugs in CKD
	29.4	 Concluding Remarks
	References
30: Pregnancy and Chronic Kidney Disease
	30.1	 Prepregnancy Assessment and Counselling
	30.2	 Normal Pregnancy
	30.3	 CKD and the Prospects for Pregnancy
	30.4	 Pregnancy in Women with CKD
	30.5	 Antenatal Strategy and Decision-Making
		30.5.1	 Kidney Function
		30.5.2	 Temporary Dialysis
		30.5.3	 Blood Pressure
		30.5.4	 Role of Kidney Biopsy in Pregnancy
		30.5.5	 Timing of Delivery
	30.6	 Postpartum Care
	30.7	 Systemic Lupus Erythematosus (SLE)
		30.7.1	 SLE and the Foetus
	30.8	 Suspicion and/or Diagnosis of De Novo CKD During Pregnancy
	30.9	 Loss of Kidney Function in Pregnancy and Afterwards in Women with CKD
	30.10	 Preeclampsia: Diagnosis, Significance, and Prognosis (Boxes 30.9 and 30.10)
	References
31: Surgery and Chronic Kidney Disease
	31.1	 Setting the Context for Surgery in the Patient with CKD
		31.1.1 Prevalence of CKD
		31.1.2 Impact of CKD on Perioperative Outcomes
	31.2	 Preoperative Considerations and Evaluation
		31.2.1 Preoperative Evaluation in Patients with CKD
		31.2.2 Preoperative Optimization of Blood Pressure and Heart Failure Therapy
		31.2.3 Preoperative Optimization of Blood Glucose Control
		31.2.4 Preoperative Optimization of Phosphate and Parathyroid Hormone
		31.2.5 Preoperative Optimization of Fluid and Electrolyte Status
		31.2.6 Preoperative Optimization of Nutritional Status
		31.2.7 Preoperative Management of Anemia
		31.2.8 Reducing Bleeding Risk
		31.2.9 Preoperative Management of Medications
		31.2.10 Prehabilitation
		31.2.11 Preemptive Dialysis for Patients with ESKD
	31.3	 Intraoperative Care for Patients with CKD
		31.3.1 The CKD Patient in the Operating Room (OR)
			31.3.1.1	 Monitoring
			31.3.1.2	 Vascular Access
		31.3.2 Anesthesia in Patients with CKD
			31.3.2.1	 Intravenous Anesthetic Agents
			31.3.2.2	 Inhalational Anesthetics
			31.3.2.3	 Neuromuscular Blocking Agents (NMBAs)
		31.3.3 Non-depolarizing NMBAs
		31.3.4 Depolarizing NMBAs
			31.3.4.1	 Reversal Agents for NMBAs
			31.3.4.2	 Analgesics
			31.3.4.3	 Regional and Neuraxial Anesthesia as an Option in CKD
			31.3.4.4	 Hemodynamic and Fluid Status Optimization
			31.3.4.5	 Hemodynamic Management Using Static Parameters
			31.3.4.6	 Hemodynamic Management Using Dynamic Parameters
			31.3.4.7	 Low Cardiac Output in Patients with CKD
			31.3.4.8	 Transesophageal Echocardiography (TEE)
			31.3.4.9	 Fluid Choices
			31.3.4.10	 Perioperative Renal Protection
	31.4	 Postoperative Care
		31.4.1 Early Detection of CKD Patients at High Risk for AKI
		31.4.2 Postoperative Prevention of AKI in Patients at High Risk
	References
32: Chronic Kidney Disease in the Elderly
	32.1	 Management of CKD in Elderly
	32.2	 Emerging Role of Conservative Management of CKD in Elderly
	32.3	 Facilitating Advance Care Planning
	32.4	 Conclusions
	References
33: Chronic Kidney Disease and Cancer
	33.1	 Introduction
	33.2	 Assessment of GFR in Cancer Patients
	33.3	 Etiologies of CKD in Cancer Patients
		33.3.1	 Chemotherapy and Targeted Therapy Induced CKD
		33.3.2	 Paraneoplastic Glomerular Disease and CKD
		33.3.3	 CKD Associated with Hematopoietic Stem Cell Transplantation (HSCT)
		33.3.4	 CKD Associated with Renal Cell Carcinoma
		33.3.5	 CKD Associated with Paraproteins and Plasma Cell Disorders
	33.4	 Consequences of CKD in Cancer Patients
	33.5	 Risk of Cancer in CKD Patients
	33.6	 Dosing of Chemotherapeutic Medications in CKD
	33.7	 Conclusion
	References
34: Chronic Kidney Disease in the Intensive Care Unit
	34.1	 Introduction
		34.1.1	 Epidemiology of CKD and ESKD in ICU
		34.1.2	 Precipitants for Critical Illness in CKD and ESKD
		34.1.3	 Outcomes for CKD and ESKD in ICU
		34.1.4	 Prognostic Scoring for CKD and ESKD in ICU
	34.2	 ICU Support of the Patient with Chronic Kidney Disease
		34.2.1	 Hemodynamic Monitoring and Mechanical Ventilation Support
		34.2.2	 Fluid, Electrolyte, and Acid-Base Management
		34.2.3	 Nutritional Support
		34.2.4	 Sepsis
		34.2.5	 Acute Kidney Injury
		34.2.6	 Renal Replacement Therapy
		34.2.7	 Pharmacotherapy
	34.3	 Conclusions
	References
35: Chronic Kidney Disease Management Programs and Patient Education
	35.1	 Chronic Kidney Disease Management Programs
	35.2	 Barriers to Development of CKD Management Programs
	35.3	 Can CKD Programs Be Successful and Improve Outcomes?
	35.4	 Development of a CKD Management Program
	35.5	 Health Literacy Within Chronic Kidney Disease
	35.6	 Patient Education in Chronic Kidney Disease
	35.7	 Guidance on Patient Education in Chronic Kidney Disease
		35.7.1	 Multidisciplinary Team
		35.7.2	 Structure
		35.7.3	 Topics Covered
		35.7.4	 Resources
		35.7.5	 Learning Style/Teaching Method
		35.7.6	 Timing of Education
	35.8	 Use of Technology for Patient Education on Chronic Kidney Disease
	References
36: Conservative/Palliative Treatment and End-of-Life Care in Chronic Kidney Disease
	36.1	 Supportive or Palliative Care in CKD
	36.2	 End-of-Life Care in CKD
	36.3	 Establishing and Achieving Goals of End-of-Life Care
	36.4	 Advance Care Planning
	References
37: How to Prepare a Chronic Kidney Disease Patient for Transplantation?
	37.1	 Time for Referring to Transplant
	37.2	 Evaluation of a Potential Renal Transplant Recipient
	37.3	 Medical Evaluation of a Potential Renal Transplant Recipient
		37.3.1	 Age
		37.3.2	 Obesity
		37.3.3	 Diabetes Mellitus
		37.3.4	 Infections
		37.3.5	 Pulmonary Evaluation
		37.3.6	 Cardiovascular Diseases
		37.3.7	 Malignancies
		37.3.8	 Urologic Disorders
		37.3.9	 Etiology of Kidney Disease
		37.3.10 Gastrointestinal Disorders
		37.3.11 Hematological Disorders
		37.3.12 Psychiatric/Psychosocial Evaluation
		37.3.13 Immunologic Evaluation
		37.3.14 Follow-Up in the Waiting List
	References
38: How to Prepare a Chronic Kidney Disease Patient for Dialysis
	38.1	 The Importance of Preparation Before Dialysis Initiation
	38.2	 Objectives of Adequate Preparation for Dialysis
	38.3	 Selection of the Patient
	38.4	 Selection of Dialysis Modality
		38.4.1	 Hemodialysis Versus Peritoneal Dialysis
			38.4.1.1	 Hemodialysis
			38.4.1.2	 Peritoneal Dialysis
	38.5	 Timely Initiation of Dialysis
	38.6	 Retarding Initiation of Dialysis
	38.7	 Problems in Preventing Urgent Dialysis
	38.8	 Myths Associated with Dialysis
	References
39: Quality of Life in Chronic Kidney Disease
	39.1	 What Is Quality of Life and What Does It Mean for CKD Patients?
	39.2	 What Is Known About HRQoL in Kidney Disease?
	39.3	 Methods to Assess Quality of Life in CKD
		39.3.1	 Generic Versus Disease-Specific Questionnaires
		39.3.2	 Utility-Based Quality of Life
	39.4	 What Quality of Life Measure Should I Use?
	39.5	 Measuring HRQoL in Special CKD Groups: End-of-Life Care for the Elderly and Caregivers
		39.5.1	 The Elderly and End-of-Life Care
		39.5.2	 Caregivers
	39.6	 Detailed Review of Most Common Instruments Used to Assess HRQoL in CKD
	39.7	 What Should I Do to Improve HRQoL for My Patients?
	References
Index