What exactly is chronic kidney disease (CKD), what causes it and how is it diagnosed? In this article we get down to the basics of defining what CKD is, and explore the stages of CKD. We review CKD progression and the assessment and management recommendations for each stage of CKD.
Over the past five years there have been dramatic changes to the way in which people with chronic kidney disease (CKD) are being managed in primary care. As a result of policy changes there are now many more people with CKD being identified, especially those with stage 3A. This article deals with one of the most important issues for healthcare professionals when caring for people with early CKD – how to tell people that they have the condition and how to best manage it.
People with advanced kidney disease are required to make many choices about their treatment throughout the journey of this disease. Opting not to have dialysis or to withdraw from treatment is a difficult decision and there are many factors that influence patients' decisions. For those who choose not to have dialysis, the implications need to be understood by the patient, their family and carers and healthcare professionals involved in their care. This article provides an update on this important issue to equip primary care professionals with a clear understanding of end-of-life care for patients with advanced kidney disease.
Chronic kidney disease (CKD) has a high mortality rate once it reaches the most severe stage. However, complications can be reduced and even prevented if it is diagnosed and treated earlier. Many people who develop CKD become symptomatic only when the disease is well established. By that point, the opportunity for some of the interventions aimed at minimising the impact of the disease has passed. Nurses working in general practice are well placed to recognise people at risk for CKD, diagnose them early and ensure that treatment is initiated and optimised to protect their renal and cardiovascular health.
The prevalence of atrial fibrillation (AF) is increasing with the ageing population. It is well worth detecting and treating as it carries a significant risk of debilitating disease, including stroke and heart failure. This article explains some of the health risks and describes simple actions that can play an important part in both the prevention and management of AF and its consequences.
The White Paper, Saving lives: our healthier nation (1999), set out a target to reduce the death rate from coronary heart disease and related illnesses such as stroke by 40% in the under-75s by 2010; recent trends indicate that this target will be met. Although the past forty years have seen a significant reduction in age-standardised stroke mortality rates, stroke still accounts for around 53,000 deaths each year in the UK, with more than 9,500 of these occurring in the under-75s. This article reviews how we might reduce the huge burden of stroke by improving the management of transient ischaemic attack (TIA).
Weight loss (bariatric) surgery is becoming increasingly common as the obesity epidemic continues to flourish, and recent NICE guidelines have supported this approach. In this article, we review the procedures used in bariatric surgery, the impact on patients' cardiovascular risk and type 2 diabetes, what the guidelines recommend and the long-term care of patients who have undergone this type of surgery.
Each year there are 150,000 strokes in the UK. Nearly one in five (18%) of the people presenting with a stroke are in atrial fibrillation (AF) at the time of presentation, and one in six strokes are directly attributable to AF.
The risk of stroke in AF is reduced by two-thirds with oral anticoagulation, while antiplatelet therapy reduces stroke by one-fifth. The reduction with antiplatelet therapy is broadly consistent with the stroke reduction seen with this therapy in patients with vascular disease or risk factors, and, given that AF largely coexists with vascular disease, the effect of antiplatelet therapy would probably reflect this. The risk of stroke is similar with paroxysmal or permanent AF, in the presence of associated risk factors.