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Most nephrology nurses are aware that the number of individuals with chronic kidney disease (CKD) is a worldwide health problem. The National Kidney Foundation (NKF) estimates that there are over 20 million people in the United States who have CKD and 20 million more who are at increased risk (NKF, n.d.a). By the year 2010, over 600,000 individuals will be receiving some form of renal replacement therapy at a projected cost of greater than $28 billion dollars a year (see Figure 1). One of the biggest problems in the U.S. is that CKD is under diagnosed and, therefore, under treated. As a result, interventions are not instituted early enough to slow the progression of the disease and prevent possible complications. To address this issue, NKF (2002) has established an operational definition and classification system for CKD (see Tables 1 & 2), which will help health care providers, including nurses, develop appropriate clinical action plans.
Understanding the eGFR
According to the NKF (2002), early screening and identification of the stage of CKD is essential for health promotion and to slow the progression of the disease. The screening for CKD, as recommended in the Kidney Disease Outcomes Quality Initiative (NKF, 2002), includes a basic metabolic profile, urinalysis, albumin and/or protein to creatinine ratio on a spot urine sample, and calculated or estimated glomerular filtration rate (eGFR). Of the screening tests recommended, it has been determined that the best indicator of kidney function is the eGFR. Use of the serum creatinine alone is not a reliable marker to screen for CKD because it may underestimate the severity of the problem. This occurs because of the wide range of normal values for serum creatinine and the factors that affect the serum concentration of creatinine. These factors include tubular secretion, generation, and extra-renal excretion of creatinine as well as older age, gender, diet, body habitus, and certain medications such as trimethoprim, cimetidine, and fibric acid derivatives (other than gemfibrizil) which increase the serum creatinine by reducing its...