n CME : Your SA Journal of CPD - Chronic kidney disease - the silent epidemic : main article



  • Chronic kidney disease (CKD) is defined as kidney damage or a glomerular filtration rate (GFR) of < 60 ml/min/1.73 m2 for 3 months or more.
  • As many as 1 in 10 adults is affected, with diabetic nephropathy, glomerulonephritis and uncontrolled hypertension being the major causes.
  • The global burden of CKD is expected to increase in parallel with the increase in diabetes - the developing world bearing the brunt of this epidemic.
  • The major consequences of CKD are end-stage renal disease (ESRD) and premature death from cardiovascular disease (CVD).
  • A patient with CKD is far more likely to die of CVD than to reach ESRD.
  • CKD is a very strong risk factor for CVD, justifying lower targets for blood pressure and lipid control.
  • The management of ESRD is extremely costly; therefore the emphasis must be on the early detection and treatment of CKD, which is very effective in preventing progression to ESRD and in decreasing the morbidity and mortality from CVD.
  • Management involves maintaining a healthy weight, increasing physical activity, reducing salt intake, smoking cessation, and treating hypertension and hyperlipidaemia, including the use of drugs that block the renin-angiotensin system.
  • Effective action is required at national and international levels to combat this global public health problem, and co-operation across disciplines is essential.


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