Learning objectives
- Recognize chronic kidney disease (CKD)
- Management of CKD
Definition and mechanisms
- A slow and gradual loss of kidney function over a period of months to years
- Retention of fluid and waste products
- Can get worse over time and may lead to kidney failure
Signs & symptoms
Few symptoms in the early stages of CKD
- Nausea
- Vomiting
- Loss of appetite
- Fatigue
- Sleep problems
- Increased or decreased urination
- Headaches
- Muscle cramps
- Swelling of feet and ankles
- Dry, itchy skin
- Hypertension
- Shortness of breath
- Chest pain
- Weight loss
- Blood in urine
Stages of CKD
| CKD stage | eGFR (ml/min/1.73m²) | Description |
|---|---|---|
| 1 | >90 | Kidney damage with normal GFR |
| 2 | 60-89 | Kidney damage with mildly decreased GFR |
| 3 | 30-59 | Moderately decreased GFR |
| 4 | 15-29 | Severly decreased GFR |
| 5 | <15 | Kidney failure |
Causes
- Hypertension
- Diabetes
- High cholesterol
- Kidney infection
- Glomerulonephritis
- Polycystic kidney disease
- Heart disease/failure
- Longterm regular use of lithium or NSAIDs
Complications
| System | Effects |
|---|---|
| Cardiovascular system | Hypertension Ischemic heart disease Pericarditis Heart failure |
| Respiratory system | Pulmonary edema Pleural effusion Respiratory infection |
| Central nervous system | Autonomic neuropathy Coma |
| Hematological | Perioperative anemia Bleeding tendency |
| Gastro-intestinal | Stress ulcertion Delayed gastric emptying |
| Renal and metabolic | Fluid retention Hyperkalemia Metabolic acidosis |
| Immunological aspects | Immunosuppressant |
Management
Keep in mind
- Decreased renal function can prolong anesthetic drug effects by decreased elimination of these agents
Suggested reading
- Domi R, Huti G, Sula H, et al. From Pre-Existing Renal Failure to Perioperative Renal Protection: The Anesthesiologist’s Dilemmas. Anesth Pain Med. 2016;6(3):e32386. Published 2016 May 14.
- Sladen RN. Chronic kidney disease: the silent enemy?. Anesth Analg. 2011;112(6):1277-1279.
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