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  • Abnormally elevated serum creatinine for 3 or more months.
  • Calculated glomerular filtration rate (GFR) ≤60 mL/minute/1.73 m2 for 3 or more months.
  • Clinical manifestations of the uremic syndrome in patients with advanced kidney failure.

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The National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) has defined chronic kidney disease (CKD) as (1) kidney damage for 3 or more months, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR, manifested by either pathologic abnormalities or markers of kidney damage, including abnormalities in the composition of the blood or urine or in imaging tests; or (2) GFR ≤60 mL/minute/1.73 m2 for 3 or more months, with or without markers of kidney damage. The NKF-K/DOQI recommends using the equation derived from the Modification of Diet in Renal Disease (MDRD) to estimate GFR from the serum creatinine (eGFR) and has proposed a classification of CKD based on level of eGFR (Table 17–1).

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Table 17–1. Classification of Chronic Kidney Disease and Management Recommendations.1
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CKD with decreased GFR (stages 2 through 5 of the NKF-K/DOQI classification), also known as chronic renal failure or chronic renal insufficiency in the literature prior to the NKF-K/DOQI classification, is a clinical syndrome that results from progressive decline of the GFR, typically over months to years, and is due to irreversible destruction of nephrons independent of the cause. In stage 2, the only manifestation of CKD may be a persistently decreased eGFR. As the GFR continues to decline (stages 3 and 4), other laboratory abnormalities begin to appear. The uremic syndrome refers to a constellation of symptoms and signs that occurs in patients with advanced kidney failure (typically GFR <10–15 mL/minute/1.73 m2) and reflects generalized organ dysfunction (stage 5). At this stage, kidney replacement therapy with dialysis or transplantation becomes necessary to sustain life. End-stage renal disease (ESRD) is an administrative term based on conditions for payment of health care by the Medicare ESRD program for patients treated by dialysis and/or transplantation in the United States.

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It has been estimated that 8.3 million Americans have an eGFR ≤60 mL/minute/1.73 m2. Moreover, in the year 2002 alone, 100,359 patients began kidney replacement therapy ...

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