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Chronic Kidney Disease (Partial Update): Early Identification and Management of Chronic Kidney Disease in Adults in Primary and Secondary Care

The Renal National Service Framework (NSF), and the subsequent NICE Clinical Practice Guideline for early identification and management of adults with chronic kidney disease (CKD) in primary and secondary care (CG73), served to emphasise the change in focus in renal medicine from treatment of established kidney disease to earlier identification and prevention of kidney disease.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: July 2014

Acute Kidney Injury: Prevention, Detection and Management Up to the Point of Renal Replacement Therapy [Internet]

Acute kidney injury (AKI), previously called acute renal failure, has chiefly been described as a syndrome since World War 2. Traditionally ‘acute renal failure’ was regarded as a less common organ failure, with patients typically requiring dialysis and managed by nephrologists. This view has now been overturned. AKI encompasses a wide spectrum of injury to the kidneys, not just ‘kidney failure’. It is a common problem amongst hospitalised patients, in particular the elderly population whose numbers are increasing as people live longer. Such patients are usually under the care of doctors practicing in specialties other than nephrology. For normal function the kidneys require a competent circulation. Conversely, it is known that renal function is vulnerable to even relative or quite modest hypotension or hypovolaemia. Hence AKI is a feature of many severe illnesses. Although these illnesses may affect many organs, the simple process of monitoring urine output and/or creatinine permits detection of AKI.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: August 2013
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Is antioxidant therapy beneficial for people with chronic kidney disease?

People with chronic kidney disease (CKD) have high risk of developing heart disease and dying prematurely. Although heart disease has many causes, damage caused by poor oxygen exchange in the body's cells (oxidative stress) is thought to be a major problem. People with CKD often have evidence of oxidative stress and this is positively associated with the rate of kidney disease progression. We assessed current evidence to evaluate how antioxidant therapy influenced outcomes for patients with CKD. Overall, we found that antioxidant therapy did not reduce the risk of heart disease or death in people with CKD, but that this could vary depending on CKD stage. There was some evidence to suggest that people on dialysis may benefit from antioxidant treatment, and that these therapies could reduce the risk of kidney disease becoming worse. However, these results are based on very limited evidence and further studies are needed to confirm if antioxidant therapy could be of benefit for people with CKD.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Anaemia Management in Chronic Kidney Disease: Partial Update 2015 [Internet]

Anaemia is defined internationally as a state in which the quality and/or quantity of circulating red blood cells is below normal. Blood haemoglobin (Hb) concentration serves as the key indicator for anaemia because it can be measured directly and has an international standard. In response to low tissue oxygen levels in anaemia the kidney produces the hormone erythropoietin which stimulates the bone marrow to produce red blood cells. A major cause of the anaemia of chronic kidney disease (CKD) is a reduction in erythropoietin production due to kidney damage.

NICE Clinical Guideline - National Clinical Guideline Centre (UK).

Version: June 2015

Sucroferric oxyhydroxide (Velphoro) for chronic kidney disease: Overview

Sucroferric oxyhydroxide (trade name: Velphoro) has been approved in Germany since August 2014 for treating chronic kidney disease in adults by regulating phosphate levels.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 2, 2015

Chronic Kidney Disease Stages 1–3: Screening, Monitoring, and Treatment [Internet]

The objective was to systematically review and synthesize evidence regarding benefits and harms of screening for and monitoring and treatment of chronic kidney disease (CKD) stages 1–3.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: January 2012
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Biomarkers for Assessing and Managing Iron Deficiency Anemia in Late-Stage Chronic Kidney Disease [Internet]

Anemia is a common complication of chronic kidney disease (CKD) that develops early in the course of CKD, and becomes increasingly severe as the disease progresses. The management of anemia in CKD patients requires an appropriate balance between stimulating the generation of erythroblasts (erythropoiesis) and maintaining sufficient iron levels for optimum hemoglobin (Hb) production. Thus, assessing iron status is integral to both iron and anemia management in CKD patients, as iron is essential for Hb formation (as is erythropoietin). However, classical laboratory biomarkers of iron deficiency exhibit a wide biological variability in CKD. In response, newer, less-variable markers have been proposed.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: October 2012
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Peritoneal Dialysis: Peritoneal Dialysis in the Treatment of Stage 5 Chronic Kidney Disease

Two main types of dialysis are available, haemodialysis and peritoneal dialysis. The main factors that determine what type of dialysis people with chronic kidney disease have are patient preferences about which treatment fits best within their lifestyle, availability of options within a service and clinical contraindications. Factors patients and carers may need to consider about peritoneal dialysis are: the ability to carry out dialysis themselves; the support services they need to carry out dialysis; integration of dialysis with work, school, hobbies, and social and family activities; opportunities to maintain social contacts; possible modifications to their home; the distance and time travelling to hospital; flexibility of daily treatment, diet and medication regimens; and possible changes to body image and physical activities because of dialysis access points.

NICE Clinical Guidelines - National Institute for Health and Clinical Excellence (UK).

Version: July 2011
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Hyperphosphataemia in Chronic Kidney Disease: Management of Hyperphosphataemia in Patients with Stage 4 or 5 Chronic Kidney Disease

Chronic kidney disease (CKD) describes abnormal kidney function and/or structure. It is common and often exists together with other conditions, such as cardiovascular disease and diabetes.

NICE Clinical Guidelines - National Institute for Health and Clinical Excellence (UK).

Version: March 2013

Protein restriction for children with chronic kidney disease

Low protein diet can delay kidney failure in adults with kidney disease, however a diet low in protein in children raises concern of poor growth. The review identified 2 studies (250 children) in children with kidney disease and found that a low protein diet does not delay progression to kidney failure (end‐stage kidney disease). There remains some concern regarding adverse effect on growth.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Cordyceps sinensis (a Chinese medicinal herb) for treating chronic kidney disease

People with chronic kidney disease (CKD) experience gradual worsening of kidney function. Cordyceps (Cordyceps sinensis), which is sometimes known as Chinese caterpillar fungus, is widely used in traditional Chinese medicine to treat people with CKD. We conducted this review to investigate if Cordyceps was a safe and effective treatment for people with CKD.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Interventions for bone disease in children with chronic kidney disease

Chronic kidney disease (CKD) resulting in reduced kidney function and the need for dialysis and kidney transplant is associated with abnormalities in blood calcium and phosphorus levels leading to high levels of the parathyroid hormone (PTH) and to bone disease. This may result in bone deformities, bone pain, fractures and reduced growth rates. Commonly used treatments (Vitamin D compounds and phosphate binders) aim to prevent or correct these outcomes. However these treatments may raise levels of blood calcium, allow calcium and phosphorus deposition in blood vessels and lead to early cardiovascular disease, which is known to be a problem in adults with CKD. This review identified only 15 small RCTs involving 369 children comparing different vitamin D compounds, different routes and frequencies of administration of vitamin D compounds and different phosphate binders. Only five RCTs reported on growth rates and no differences were detected between treatments. Renal bone disease, as assessed by changes in PTH levels, was improved by all vitamin D preparations regardless of preparation used or the route or frequency of administration. Fewer episodes of high blood calcium levels and lower overall serum calcium levels occurred with the non calcium‐containing binder, sevelamer, compared with calcium‐containing binders. As newer treatments for renal bone disease are developed, comparisons with the current standard therapies will be required in well designed RCTs in children using outcome measures including those of direct clinical relevance to children and their families such as rates of growth, reduction in bone fractures and bone pain and reduction in calcification in blood vessels.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

There is some evidence that human growth hormone may help reduce growth problems in children with chronic kidney disease

The kidneys filter blood. Children with chronic kidney disease (CKD) may progress to end‐stage kidney failure and need their blood filtered by machine (dialysis) or they need a kidney transplant. CKD can stunt growth in children. Growth hormone (rhGH) has been used to help children grow to a more average height for their age but rhGH may have adverse effects including added risk of transplant rejection and high pressure in the brain. This review of 16 studies enrolling 809 children found that rhGH increased height in children with CKD by about 4 cm after 1 year and by a further 2 cm after 2 years of treatment compared with no treatment. The frequency of reported side effects of rhGH was generally similar to that of the control group.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Rheum officinale (a traditional Chinese medicine) for the treatment of chronic kidney disease

Chronic kidney disease (CKD) is a long‐term, life threatening illness that is becoming more common. People who have CKD are monitored closely and treated with therapies that are determined according to the stage of their illness and whether they have other health problems. Treatment for CKD often involves drugs to control blood pressure and aid kidney function ‐ often angiotensin‐converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) ‐ along with restricting the amount of protein consumed. Practitioners of traditional Chinese medicine often use Rheum officinale (Da Huang, a type of rhubarb) to treat people with CKD.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Vitamin D compounds for people with chronic kidney disease requiring dialysis

People with reduced kidney function (chronic kidney disease; CKD) develop changes in circulating blood levels of calcium and phosphorus. The kidney gradually loses the ability to remove phosphorus from the blood and cannot activate adequate amounts of vitamin D, to maintain normal levels of calcium. The parathyroid gland senses these changes and compensates to increase calcium by elevating production and release of parathyroid hormone. These metabolic changes alter bone metabolism to release calcium and accordingly lead to bone abnormalities including altered bone production. Consequently bone deformation, bone pain, and altered risks of fracture may occur.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Darbepoetin alfa to treat anaemia in people with chronic kidney disease

People who have chronic kidney disease (CKD) frequently experience anaemia. Several different medicines that treat anaemia are available including darbepoetin alfa.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Vitamin D compounds for people with chronic kidney disease not requiring dialysis

People with lower kidney function (chronic kidney disease; CKD) develop changes in circulating blood levels of calcium and phosphorus. The kidney gradually loses the ability to remove phosphorus from the blood and cannot activate adequate amounts of vitamin D to maintain normal levels of calcium. The parathyroid gland senses these changes and compensates to increase calcium by elevating production and release of parathyroid hormone (PTH). These metabolic changes alter bone metabolism to release calcium and accordingly lead to bone abnormalities including altered bone production. In turn, bony changes may result in bone deformation, bone pain, and altered risks of fracture.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Phosphate binders for preventing and treating bone disease in chronic kidney disease patients

People with chronic kidney disease (CKD) develop impaired excretion of the dietary phosphorus. This results in a condition known as mineral and bone disorder in chronic kidney disease (CKD‐MBD). CKD‐MBD is characterized by high bone turnover, increased musculoskeletal morbidity including bone pain and muscle weakness, and vascular calcification which may contribute to the high incidence of cardiovascular disease and associated deaths. Several agents such as phosphate binders, vitamin D compounds, and calcimimetics are widely used to slow the development and progression of CKD‐MBD complications.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Interventions for treating sexual dysfunction in men and women with chronic kidney disease

Sexual dysfunction is very common in patients with chronic kidney disease (CKD). Men with CKD frequently suffer from reduced libido, erectile dysfunction and difficulty reaching orgasm. Approximately 50% to 80% of men with CKD have erectile dysfunction and the prevalence has been found to increase with age. For women with CKD, 55% report difficulty with sexual arousal. Dysmenorrhoea, delayed sexual development, impaired vaginal lubrication, dyspareunia and difficulties in reaching orgasm are also frequently observed. Therapies that have been used to treat sexual dysfunction include phosphodiesterase‐5 inhibitors (PDE5i), intracavernous injections, intraurethral suppositories, hormonal therapy, mechanical devices and psychotherapy. Although many clinical studies and reviews have explored the role of these interventions for sexual dysfunction in patients without CKD, the effectiveness and safety of these interventions in patients with CKD have not yet been studied thoroughly. The aim of this review was to assess the benefits and harms of existing interventions for treating sexual dysfunction in patients with CKD.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Astragalus (a traditional Chinese medicine) for treating chronic kidney disease

Chronic kidney disease affects increasing numbers of people around the world, but as yet, effective strategies to control its progression have not been universally accepted. Astragalus is one of most widely used herbs for treating kidney disease. We conducted this review to evaluate the benefits and potential harms of Astragalus for the treatment of people with chronic kidney disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

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