In the early stages of chronic kidney disease (I, II), only few and very generic symptoms appear. Presentation of symptoms become apparent when the kidney function is significantly impaired, starting from stage III.
The conservative treatment in CKD, composed of a combination of pharmaceutical and medical nutrition therapy, focuses on slowing the progression of the kidney damage by controlling the underlying cause and managing the symptoms.
Renal replacement therapy
Patients with severely impaired kidney function and need for renal replacement therapy should be offered a choice of RRT in terms of start and type of dialysis or kidney transplantation.
According to the updated NICE guideline the start of dialysis should be considered according to the impact of uraemia on daily living, or biochemical measures of uncontrollable fluid overload, or at an estimated glomerular filtration rate (eGFR) of around 5-7 ml/min/1.73m² if there are no symptoms. It is recommended to ensure, that the decision to start dialysis is made together with the patient and the family/caregivers.
- Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascular disease in chronic kidney disease. J Am Soc Nephrol 1998; 9:16-23.
- Schiffrin EL, Lipman ML, Mann JF. Chronic kidney disease: effects on the cardiovascular system. Circulation 2007: 116:85-97.