ABSTRACT
Chronic kidney disease (CKD) is a progressive, irreversible and long-term condition, and involves an abnormality in one or both kidneys and a loss of renal function which may or may not include kidney damage. Kidney damage is caused by disease of the kidney itself, glomerulonephritis (that is, inflammation of the nephron, the unit structure of the kidneys) or by diseases that affect multiple organs, such as in diabetes (Redmond and McClelland 2006). As kidney function deteriorates, the risk of complications increases, i.e. anaemia and renal bone disease. In the early stages, CKD can be almost undetectable; however, in some people it will progress to established renal failure (ERF), which is when the kidneys no longer function and the patient needs renal replacement therapy (RRT). CKD is increasingly recognised as a public health problem as the majority of people with this condition are asymptomatic and may not be aware that they have any form of kidney problem (Holcomb 2005; Royal College Physicians (RCP) 2008). The incidence of people with ERF in the United Kingdom (UK) is also increasing (The Renal Association, UK Renal Registry 2003). CKD affects approximately 10 per cent of the population (Coresh et al. 2003). Worldwide, it is estimated that over 1.1 million patients with ERF currently require maintenance dialysis, which is increasing at a rate of 7 per cent per year (Lysaght 2002). If the trend continues, by 2010 the number will exceed two million (Xue et al. 2001). In the UK at the end of 2006, 43,901 patients were receiving RRT (The Renal Association, UK Renal Registry 2007).
