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Kidney Failure

The number of patients with end-stage renal disease (ESRD) is increasing rapidly in the United States. More than 3 million US patients will have significant chronic renal failure (CRF) by the year 2008.

Detection of Renal Disease

Diabetes and hypertension are the two most common causes of CRF in patients with ESRD, accounting for more than two-thirds of cases in these patients. Such patients, along with other high-risk patients (family history of renal disease, known chronic glomerulonephritis), should undergo regular screening for significant renal disease. Screening tools include

Management of Kidney Failure

Blood Pressure Control

Target blood pressure for patients with CRF is 130/85 mm Hg. In patients with more than 3 g/day of proteinuria, the progression of renal disease can be slowed even further if the patient's blood pressure is less than

Anemia of Renal Failure

The availability of recombinant human erythropoietin (r-HuEPO) to treat the anemia of renal failure has dramatically reduced the morbidity and mortality of patients with advanced CRF. The correction of anemia in patients with CRF not

Access for Long-Term Dialysis

The timely provision of access for long-term dialysis has numerous benefits for patients with CRF, including an improved survival, a greater likelihood of creation of a native arteriovenous fistula, a higher probability for choosing a self-dialysis

Patients who must urgently initiate long-term dialysis without a permanent dialysis access have a 1-year mortality rate of 20 to 30%, which is greater than the usual 1-year mortality rate of 15 to 20%. This increase in mortality may be due to

The National Kidney Foundation currently recommends that a long-term hemodialysis access should be created when the serum creatinine level reaches 4.0 mg/dL (GFR less than 20 mL/min). In my opinion, access should be created when

Nutritional Care

Malnutrition, as determined by the presence of hypoalbuminemia, at initiation of dialysis is associated with an increased mortality in patients with ESRD. Patients with CRF who have an albumin level lower than 3.0 g/dL have a 2-year mortality

Specialist Referral

At some point, the patient with advanced renal failure should be referred to a nephrologist. Assessment by a nephrologist before the initiation of dialysis therapy? Early referral to a nephrologist facilitates provision of a permanent kidney failure, kidney transplant, transplantation, donor organ, early acceptance programs Patients should be referred for a kidney transplant