NCLEX Review Guide: Chronic Kidney Disease (CKD)

CKD Overview

• Chronic Kidney Disease (CKD) is the progressive, irreversible loss of kidney function over months to years, characterized by GFR <60 mL/min/1.73m² for ≥3 months.
• CKD progresses through 5 stages based on GFR: Stage 1 (≥90), Stage 2 (60-89), Stage 3 (30-59), Stage 4 (15-29), Stage 5 (<15 or dialysis).

Uremic Syndrome

• Uremic frost appears as white crystals on skin when BUN >200 mg/dL, indicating severe uremia requiring immediate dialysis.
• Neurological changes include confusion, seizures, and peripheral neuropathy due to uremic toxin accumulation.

Cardiovascular Complications

• Pericarditis manifests as chest pain and pericardial friction rub, often indicating need for urgent dialysis.
• Hypertension occurs in >90% of CKD patients due to fluid retention and renin-angiotensin system activation.

Metabolic Complications

• Renal osteodystrophy develops from impaired vitamin D activation and phosphorus retention, leading to bone pain and fractures.
• Anemia occurs when GFR <30 due to decreased erythropoietin production.

Dietary Management

1. Restrict protein to 0.8-1.0 g/kg/day to reduce uremic toxin production
2. Limit phosphorus to 800-1000 mg/day and administer phosphate binders with meals
3. Restrict potassium to 2-3 g/day if hyperkalemic
4. Limit sodium to 2-3 g/day for blood pressure control

Medication Management

• ACE inhibitors/ARBs are nephroprotective but require monitoring for hyperkalemia and increased creatinine.
• Avoid NSAIDs, contrast dyes, and nephrotoxic antibiotics as they can accelerate kidney damage.