Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Jul 26;13(15):4378.
doi: 10.3390/jcm13154378.

Care of Adults with Advanced Chronic Kidney Disease

Sanjivani Shrestha  1 , Kanza Haq  1 , Divyanshu Malhotra  1 , Dipal M Patel  1
Affiliations
Review

Care of Adults with Advanced Chronic Kidney Disease

Sanjivani Shrestha et al. J Clin Med. .

Abstract

Chronic kidney disease (CKD) impacts over 10% of the global population. Adults with CKD face significant morbidity and mortality. As kidney disease progresses, the risk of adverse outcomes increases. Here, we present an overview of strategies to care for adults with advanced CKD (stage 4-5 CKD, not receiving kidney replacement therapy). We aim to guide clinicians through several aspects of CKD care, ranging from recommended laboratory assessments to interdisciplinary support for patients as they plan for kidney replacement therapy (dialysis, transplantation, or conservative management). We incorporate considerations of health equity and person-centered care, empowering clinicians to deliver high-quality care to people with CKD.

Keywords: non-dialysis-dependent CKD; pre-dialysis care; supportive management.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Multifaceted care of adults with advanced CKD.
Figure 2
Figure 2
CKD heatmap, demonstrating the increase in risk of adverse outcomes for people with lower GFR and higher albuminuria levels [3]. Risk of adverse outcomes is low (green), moderately increased (yellow), high (orange), or very high (red). GFR: glomerular filtration rate.
Figure 3
Figure 3
Algorithm for evaluation and management of anemia in CKD. ESA: erythropoiesis-stimulating agent.
Figure 4
Figure 4
Components of comprehensive kidney replacement therapy (KRT) education. HD: hemodialysis; PD: peritoneal dialysis.
See this image and copyright information in PMC

References

    1. Kovesdy C.P. Epidemiology of chronic kidney disease: An update 2022. Kidney Int. Suppl. 2022;12:7–11. doi: 10.1016/j.kisu.2021.11.003. - DOI - PMC - PubMed
    1. Francis A., Harhay M.N., Ong A.C.M., Tummalapalli S.L., Ortiz A., Fogo A.B., Fliser D., Roy-Chaudhury P., Fontana M., Nangaku M., et al. Chronic kidney disease and the global public health agenda: An international consensus. Nat. Rev. Nephrol. 2024;20:473–485. doi: 10.1038/s41581-024-00820-6. - DOI - PubMed
    1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105:S117–S314. doi: 10.1016/j.kint.2023.10.018. - DOI - PubMed
    1. Hill N.R., Fatoba S.T., Oke J.L., Hirst J.A., O’Callaghan C.A., Lasserson D.S., Hobbs F.D. Global Prevalence of Chronic Kidney Disease—A Systematic Review and Meta-Analysis. PLoS ONE. 2016;11:e0158765. doi: 10.1371/journal.pone.0158765. - DOI - PMC - PubMed
    1. Glassock R.J., Winearls C. Ageing and the glomerular filtration rate: Truths and consequences. Trans. Am. Clin. Clim. Assoc. 2009;120:419–428. - PMC - PubMed

LinkOut - more resources