Fast Five Quiz: Is Your Knowledge of Chronic Kidney Disease Sufficient?

Vecihi Batuman, MD; Patrick Rossignol, MD


July 21, 2022

Depressive symptoms are common in patients with CKD, with a prevalence of 23%–29% among patients with ESRD. According to Maarse and colleagues, studies have shown that depressive symptoms are associated with adverse health outcomes in patients with ESRD. A 2014 meta-analysis found that patients with depressive symptoms have a 1.5 times higher risk for mortality. Other studies showed comparable results regarding other clinical outcomes such as hospitalization.

Patients with CKD stages I-III (glomerular filtration rate [GFR] > 30 mL/min/1.73 m²) are frequently asymptomatic; in terms of possible "negative" symptoms related simply to the reduction in GFR, they do not experience clinically evident disturbances in water or electrolyte balance or endocrine/metabolic derangements, unless they also have anemia (which may be associated with fatigue and dyspnea). Generally, these disturbances become clinically manifest at CKD stages IV-V (GFR < 30 mL/min/1.73 m²). Patients with tubulointerstitial disease, cystic diseases, nephrotic syndrome, and other conditions associated with "positive" symptoms (eg, polyuria, hematuria, or edema) are more likely to develop signs of disease at earlier stages.

A careful physical examination is imperative. It may reveal findings characteristic of the condition that is underlying CKD (eg, hypertension, severe arteriosclerosis, symptomatic diabetes, or lupus) or its complications (eg, anemia, bleeding diathesis, or pericarditis). However, the lack of findings on physical examination does not exclude kidney disease.

Learn more about the presentation and physical examination of patients with CKD.


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