End-Stage Renal Disease

Excerpt

More than 500,000 people in the United States live with end-stage renal disease (ESRD). The development of chronic kidney disease (CKD) and its progression to this terminal disease remains a significant cause of reduced quality of life and premature mortality. Chronic kidney disease (CKD) is a debilitating disease, and standards of medical care involve aggressive monitoring for signs of disease progression and early referral to specialists for dialysis or possible renal transplant. The Kidney Disease Improving Global Outcomes (KDIGO) foundation guidelines define CKD using kidney damage markers, specifically markers that determine proteinuria and glomerular filtration rate. By definition, the presence of both factors (glomerular filtration rate [GFR] less than 60 mL/min and albumin greater than 30 mg per gram of creatinine) along with abnormalities of kidney structure or function for greater than three months signifies chronic kidney disease. End-stage renal disease is defined as a GFR of less than 15 mL/min.

According to KDIGO 2012 clinical practice guideline, CKD is classified into five stages considering the GFR level.

1. Stage 1: Kidney damage with normal GFR (greater than 90 ml/min)

2. Stage 2: Mild reduction in GFR (60-89 mL/min)

3. Stage 3a: Moderate reduction in GFR (45 to 59 mL/min)

4. Stage 3b: Moderate reduction in GFR (30 to 44 mL/min)

5. Stage 4: Severe reduction in GFR (15 to 29 mL/min)

6. Stage 5: Renal failure (GFR less than 15 mL/min)