Introduction and General Principles of Chronic Kidney Disease

Chronic kidney disease (CKD) is common, afflicting nearly 40 million people in the United States and roughly 850 million worldwide. In the past, the focus for therapy has been almost exclusively on correction of the metabolic sequelae of poor electrolyte and uremic toxin excretion. More recently, a growing appreciation of the negative impact of early stages of CKD on survival has galvanized clinical and basic research efforts to address the systemic complications of CKD. Several principles can guide the clinician toward a more pro-active and holistic approach to the identification and care of a patient with CKD. These will be reviewed in this chapter. CKD is a systemic disease that affects literally every organ system of the body. The systemic complications of CKD begin early in the course of CKD, long before any of the easily recognizable disorders of fluid and electrolytes manifest. CKD is a strong predictor of early mortality, even at the early stages, and is an independent factor affecting mortality for virtually any acute or chronic illness. CKD is not a “one size fits all” condition. The primary care clinician can play a key role in identifying individuals who are at high risk for the development of CKD in order to incorporate early intervention strategies in the course.